Clinical Characteristics of Patients with Acute Pulmonary Embolism: Data from PIOPED II

Paul D. Stein, Afzal Beemath, Fadi Matta, John G. Weg, Roger D. Yusen, Charles A. Hales, Russell D. Hull, Kenneth V. Leeper, H. Dirk Sostman, Victor F. Tapson, John D. Buckley, Alexander Gottschalk, Lawrence R. Goodman, Thomas W. Wakefied, Pamela K. Woodard

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Abstract

Background: Selection of patients for diagnostic tests for acute pulmonary embolism requires recognition of the possibility of pulmonary embolism on the basis of the clinical characteristics. Patients in the Prospective Investigation of Pulmonary Embolism Diagnosis II had a broad spectrum of severity, which permits an evaluation of the subtle characteristics of mild pulmonary embolism and the characteristics of severe pulmonary embolism. Methods: Data are from the national collaborative study, Prospective Investigation of Pulmonary Embolism Diagnosis II. Results: There may be dyspnea only on exertion. The onset of dyspnea is usually, but not always, rapid. Orthopnea may occur. In patients with pulmonary embolism in the main or lobar pulmonary arteries, dyspnea or tachypnea occurred in 92%, but the largest pulmonary embolism was in the segmental pulmonary arteries in only 65%. In general, signs and symptoms were similar in elderly and younger patients, but dyspnea or tachypnea was less frequent in elderly patients with no previous cardiopulmonary disease. Dyspnea may be absent even in patients with circulatory collapse. Patients with a low-probability objective clinical assessment sometimes had pulmonary embolism, even in proximal vessels. Conclusion: Symptoms may be mild, and generally recognized symptoms may be absent, particularly in patients with pulmonary embolism only in the segmental pulmonary branches, but they may be absent even with severe pulmonary embolism. A high or intermediate-probability objective clinical assessment suggests the need for diagnostic studies, but a low-probability objective clinical assessment does not exclude the diagnosis. Maintenance of a high level of suspicion is critical.

Original languageEnglish
Pages (from-to)871-879
Number of pages9
JournalAmerican Journal of Medicine
Volume120
Issue number10
DOIs
StatePublished - Oct 1 2007

Keywords

  • Clinical diagnosis
  • Deep venous thrombosis
  • Pulmonary embolism
  • Venous thromboembolism

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    Stein, P. D., Beemath, A., Matta, F., Weg, J. G., Yusen, R. D., Hales, C. A., Hull, R. D., Leeper, K. V., Sostman, H. D., Tapson, V. F., Buckley, J. D., Gottschalk, A., Goodman, L. R., Wakefied, T. W., & Woodard, P. K. (2007). Clinical Characteristics of Patients with Acute Pulmonary Embolism: Data from PIOPED II. American Journal of Medicine, 120(10), 871-879. https://doi.org/10.1016/j.amjmed.2007.03.024