PURPOSE: To stratify acute pulmonary embolism (PE) patients into distinctive risk groups for purpose of comparing their presenting symptoms.
METHODS: Patients presenting to our hospital with acute PE from January 2005 through August 2010 were selected. We utilized the pulmonary embolism severity index (PESI) score for risk stratification. We separated the patients into 3 risk categories namely low (PESI <85), moderate (PESI 86-105) and high risk (PESI >105) PE patients. Furthermore we determined the presenting symptom for each PE patient amongst all the risk groups.
RESULTS: Data was obtained in 321 patients with acute PE. Of these patients 52% (166 of 321) were considered low risk, 25% (82 of 321) were moderate risk and 23% (73 of 321) were high risk. Syncope was present only in 4.6% (14 of 321) PE patients. However syncope had a predominant presentation amongst high risk PE patients 8.2% (6 of 73), followed by 4.8% (4 of 82) in moderate risk and 2.4% (4 of 166) in low risk groups. Dyspnea was the dominant presenting symptom amongst all the risk groups with 31% (51 of 166) in low risk, 43% (36 of 82) in moderate risk and 46.5% (34 of 73) in high risk patients. The second was chest pain with 24% (41 of 166) in low risk, 24% (20 of 82) in moderate risk and 13% (10 of 73) in high risk groups. Leg pain and swelling was the 3rd leading symptom amongst the groups.
CONCLUSIONS: Acute PE patients presented infrequently with syncope. However syncope as a presenting symptom was twice as often observed in high risk as compared to other risk categories.
CLINICAL IMPLICATIONS: PESI as a risk stratification tool for separating PE patients into different risk groups has been proposed in several studies. PESI has advantages over other prognostic tools in that it is based on readily available clinical factors. Presenting symptoms like syncope in a patient with acute PE warrant vigilance in assessment and management.
DISCLOSURE: The following authors have nothing to disclose: Ali Shafiq, Muhammad Janjua, Asim Mushtaq, Hamza Lodhi, Ahmed Alrifai, Haroon Chughtai, Syed Ali
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