Retrospective 5-year study of patients who received pulmonary embolism in emergency medical clinic of Atatürk University Faculty of Medicine

Objective: Acute PTE (Pulmonary Thromboembolism) is the third most common fatal cardiovascular disease worldwide. The mortality rate of cases who are not diagnosed or not treated properly has been reported to be 25-30%. On the other hand, mortality drops to 2-8% in cases who are diagnosed rapidly and given an appropriate treatment according to risk classification. Therefore, differential diagnosis and clinical treatment of pulmonary embolism has an important place in the practice of emergency services. The aim of this study is to analyze retrospectively patients admitted to Atatürk University Medical Faculty Emergency Department between 2012-2016 and admitted with definite diagnosis of PTE. Method: This study was carried out with retrospective screening of the patients who admitted to our emergency service between January 1, 2012 and November 31, 2016, who were examined with the suspicion of pulmonary embolism and who had the definite diagnosis. Using our Enlil Medical Bigi System, our study identified 1540 patients who underwent 'I-26' PTE diagnostic code according to the ICD 10 coding system. Patient epicrisis, laboratory results and radiology results were examined. Patients who were not 18 years of age, who were pregnant, who had pulmonary CT angiography, who had contrast allergies, epicrisis findings, echocardiography, external center CT, lack of patient information and who were discharged from the room were excluded from the study. According to the results of pulmonary CT angiography, PTE diagnosis was definite and 104 patients who were hospitalized were included in the study. Descriptive statistics, the mean ± standard deviation for the normally distributed numerical data, the median and interquartile range for the not normally distributed numerical data and the percent-ratio for the categorical data will be calculated for the patients with the diagnosis of pulmonary embolism. Findings and Results: A total of 104 patients with pulmonary thromboembolism were included in our study, out of these, 54 (51.9%) female and 50 (48.1%) male. The mean age was 66.1±15.3. In our study, 97 patients had risk factor and 7 patients did not have any risk factor. There were multiple risk factors in 62 cases. The most common risk factors were advanced age (≥65 years) (36.1%), surgery (11.5%), coronary artery disease (10.4%), diabetes mellitus (10%) and cancer (9%). Comparison two groups; the group of " 65 years and over'" and the group of "under 65 years' showed that hypertension (p = 0.042) and the presence of risk factor (p <0.001) were found to be more frequent in the group of '' 65 years and over". For the cases in the group of "under 65 years ", the ratio of splint / plaster due to fracture as a risk factor was found to be higher than other group (p = 0.001). Examination of age and laboratory data according to the presence of risk factors showed that the age was higher (p <0.001) and hemoglobin was lower (p = 0.018) in those who had risk factors. When the 30-day mortality was examined, 6 patients (5.8%) died and 98 patients (94.2%) were alive. The values of HCO3 (p = 0.021) and platelet (p <0.001) were associated with mortality and HCO3 detected mortality at a rate of 77% and platelet detected mortality at a rate of 92%. The values of RDW (p=0.039), creatinine (p=0.015) and BUN (p<0.001) were found to be higher whereas platelet (p=0.018) values were found to be lower in the group of "65 years and over" compared to the group of "under 65 years". When the groups received "anticoagulants" versus "anticoagulant + thrombolysis" were compared, there was a significant difference in terms of cost (p=0.002) whereas there was no difference in terms of hospital stay (p=0.067) and no effect on prognosis (p=0.317). Examining laboratory tests, treatment and cost according to the localization of emboli, there were statistically significant differences in terms of alkaline phosphatase (p=0.009), troponin I (p=0.006), BUN (p=0.031), total cost (p=0.002) and treatment (p<0.001). Key words: Pulmonary thromboembolism, risk factor, 65 years of age, mortality, localization of emboli