In-hospital diagnostic strategies for acute pulmonary embolism — results of a single-center study based on the experience of a multi-profile clinical hospital

Abstract

Introduction: Acute pulmonary embolism (APE) is the most severe clinical presentation of venous thromboembolism
(VTE) and inappropriate diagnostic strategies of APE lead to death or chronic thromboembolic
pulmonary hypertension.

Material and methods: In prospective manner we followed patients admitted to a tertiary clinical center
with APE proven with CT scan within the period of 24 months. We assessed diagnostic strategies of APE in
different clinical departments of Polish multi-profile hospital and their association with prognosis.

Results: A total number of 178 patients with APE were enrolled in the study, of which 56 patients were diagnosed
with APE in the emergency department (ED), 42 in cardiology departments, and 80 in other departments. No
significant differences in diagnostic strategies between departments were found. Adherence to ESC guidelines
was 56.1% and it was similar in compared departments (p = 0.648). The in-hospital mortality rate was 6.7%.
In the 6 month follow-up period 18.1% of the studied died. Coronary artery disease (p = 0.002), cancer
(p = 0.032), serious medical condition (p = 0.047), altered mental status (p = 0.032), CRP
(p = 0.006), and hemoglobin (p = 0.023) were identified as predictors of clinical deterioration. Risk factors
for in-hospital and 6-month mortality were congestive heart failure, serious medical condition, and systolic
blood pressure (p < 0.05). Immobility over 3 days and cancer were also identified as predictors of death within
6 months (p < 0.001). There was no association between the type of the department, clinical deterioration,
in-hospital, and 6-month mortality.

Conclusion: There is no difference in APE management and prognosis in different profile departments.