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Titolo:
Identification of prearrest clinical factors associated with outpatient fatal pulmonary embolism
Autore:
Courtney, DM; Kline, JA;
Indirizzi:
Carolinas Med Ctr, Dept Emergency Med, Charlotte, NC 28323 USA Carolinas Med Ctr Charlotte NC USA 28323 ncy Med, Charlotte, NC 28323 USA
Titolo Testata:
ACADEMIC EMERGENCY MEDICINE
fascicolo: 12, volume: 8, anno: 2001,
pagine: 1136 - 1142
SICI:
1069-6563(200112)8:12<1136:IOPCFA>2.0.ZU;2-G
Fonte:
ISI
Lingua:
ENG
Soggetto:
AUTOPSY; DEATH; EPIDEMIOLOGY; THROMBOSIS; EMERGENCY;
Keywords:
pulmonary embolism; sudden death; autopsy; risk factors; symptoms;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
16
Recensione:
Indirizzi per estratti:
Indirizzo: Kline, JA Carolinas Med Ctr, Dept Emergency Med, POB 32861, Charlotte, NC 28323 USA Carolinas Med Ctr POB 32861 Charlotte NC USA 28323 NC 28323 USA
Citazione:
D.M. Courtney e J.A. Kline, "Identification of prearrest clinical factors associated with outpatient fatal pulmonary embolism", ACAD EM MED, 8(12), 2001, pp. 1136-1142

Abstract

Massive pulmonary embolism (MPE) is an important cause of outpatient sudden death, and description of these patients is critical for identification and treatment. Objective: To test whether MPE patients can be distinguished from patients suffering sudden death from other causes based on clinical, demographic, and historical data. The hypothesis was that MPE cases would bemore likely to manifest components of a clinical triad of 1) overt dyspnea, 2) alteration of mental status or syncope, and 3) shock index (pulse divided by systolic blood pressure) >0.8. Methods: Retrospective case-control study of medical examiner data from 1992 to 1999 including all patients withnontraumatic death, aged 18-65 years, transported to an emergency department, with autopsy-determined cause of death. Analysis was done by 95% confidence interval (95% CI) for difference in proportions and multivariate logistic regression for odds ratios. Results: The MPE patients (n = 37) were younger than the control subjects (n = 347) (40.2 vs 46.5 years, unpaired t-test p < 0.001). At least two of the three components of the triad were present in 56.8% of MPE cases vs 3.5% of controls (95% CI for difference in proportions = 37.3% to 68.0%). Significant variables (and odds ratios) for MPE after multivariate analysis included: dyspnea (13.8), shock index >0.8 (23.6), immobilization or fracture (14.6), seen by a physician within two weeks(5.1), and African American female status (6.4). Conclusions: Patients in this community with fatal MPE were young with risk factors for pulmonary embolism, and commonly manifested components of a triad including: dyspnea, alteration of mental status/syncope, and shock prior to death.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 29/05/20 alle ore 17:06:16