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Articles: Grégoire Le Gal, Marc Righini, Pierre-Marie Roy, Olivier Sanchez, Drahomir Aujesky, Henri Bounameaux, and Arnaud Perrier Prediction of Pulmonary Embolism in the Emergency Department: The Revised Geneva Score Ann Intern Med 2006; 144: 165-171 [Abstract] [Full text] [PDF]

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Pulmonary Embolism : which problem ?

Philippe Leveau   (18 October 2006)

Pulmonary Embolism : which problem ? 18 October 2006
Philippe Leveau, MD Nord Deux Sèvres Hospital, France Send rapid response to journal: Re: Pulmonary Embolism : which problem ? leveau.philippe{at}chnds.fr Philippe Leveau	The work of Le Gal et al is very interesting. There is now a half dozen tools of assistance to the diagnosis of pulmonary embolism (PE). However, mortality by PE is the same in spite of these tools, the powerful complementary examinations and the development of thromboembolic disease prevention. In France, the incidence of PE is between 60 and 111 per 100,000 and PE cause more than 3,500 deaths annually [1]. The autopsic studies show that the prevalence of the PE among in-patients is the same since three decades, and that the diagnosis of EP is evoked only among approximately 7 patients out of 10 [2]. The principal causes of error of diagnostic are its protean clinical presentations and failure to suspect PE [3]. In spite of therapeutic and diagnostic progress, the autopsic studies show an increase of none diagnosed fatal PE [4]. In this study, only 16 percent of the PE had been diagnosed ante mortem. In addition, the weak rate of scientific autopsies involves underestimate of the false negative whatever the pathology, and thus overestimates the diagnostic performances [5]. Clinical research on PE should concentrate on methods of detection of the disease. The autopsic studies show that the majority of the fatal PE did not have evocative clinical signs, but have favorable factors of comorbidity : older, active cancers, acute medical episode in the previous weeks, congestive heart disease... If we want to have an impact on the mortality of the disease, we must find means to suspect PE even in the absence of evocative clinical signs. A clinical score could be useful for this tracking while being based on epidemiologic data like the age and the medico-surgical history of the patients. 1. Bénard E, Lafuma A, Ravaud P. Epidemiology of venous thromboembolic disease. Presse Med 2005;34: 415-19 2. Stein PD, Henry JW. Prevalence of acute pulmonary embolism among patients in a general hospital at autopsy. Chest 1995:108;978-81 3. Morpurgo M, Schmid C. The spectrum of pulmonary embolism. Clinicopathologic correlations. Chest 1995;107;18-20 4. Karwinski B, Svendsen E. Comparison of clinical and postmortem diagnosis of pulmonary embolism. J Clin Pathol 1989;42:135-139 5. Shojania KG, Burton EC, McDonald KM, Goldman L. Overestimation of clinical diagnostic performance caused by low necropsy rates. Qual Saf Health Care. 2005 Dec;14(6):408-13 Conflict of Interest: None declared