Clinical research studyClinical Characteristics of Patients with Acute Pulmonary Embolism: Data from PIOPED II
Section snippets
Patients and Methods
PIOPED II was a prospective multicenter investigation of multidetector computed-tomography angiography alone and combined with venous phase imaging of the pelvic and thigh veins for the diagnosis of acute pulmonary embolism.5 A composite reference test was used.5 Patients aged 18 years or more with clinically suspected acute pulmonary embolism were potentially eligible.5 Exclusion criteria included an inability to complete tests within 36 hours, critical illness, ventilatory support, shock,
Results
Acute pulmonary embolism was present in 192 patients, among whom 133 (69%) had no prior cardiopulmonary disease. Pulmonary embolism was excluded in 632 patients, among whom 366 (58%) had no prior cardiopulmonary disease.
Discussion
The data show a broad range of severity of clinical findings in patients with pulmonary embolism. The syndrome of pleuritic pain or hemoptysis, in the absence of circulatory collapse, was the most frequent mode of presentation in PIOPED, occurring in 65% of patients with pulmonary embolism and no prior cardiopulmonary disease.10 The present data from PIOPED II showed somewhat fewer patients with pleuritic pain or hemoptysis, and more had the uncomplicated dyspnea syndrome. Circulatory collapse
Conclusions
Symptoms may be mild and generally recognized symptoms may be absent in patients with the largest pulmonary embolism in the segmental pulmonary branches, but typical symptoms may be absent even in patients with large emboli. A high or intermediate-probability objective clinical assessment may suggest the need for diagnostic studies, but a low-probability objective clinical assessment was sometimes present, even in patients with proximal pulmonary embolism. Maintenance of a high level of
Acknowledgment
Nikunj R. Patel, MD, assisted in analyzing the data.
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This study was supported by Grants HL63899, HL63928, HL63931, HL063932, HL63940, HL63941, HL63981, HL63982, and HL67453 from the U.S. Department of Health and Human Services, Public Health Services, National Heart, Lung, and Blood Institute, Bethesda, Maryland.