Fatal pulmonary embolism in hospitalized patients. Clinical diagnosis versus pathological confirmation.
OBJECTIVE
To assess the incidence of fatal pulmonary embolism (FPE), the accuracy of clinical diagnosis, and the profile of patients who suffered an FPE in a tertiary University Hospital.


METHODS
Analysis of the records of 3,890 autopsies performed at the Department of General Pathology from January 1980 to December 1990.


RESULTS
Among the 3,980 autopsies, 109 were cases of clinically suspected FPE; of these, 28 cases of FPE were confirmed. FPE accounted for 114 deaths, with clinical suspicion in 28 cases. The incidence of FPE was 2.86%. No difference in sex distribution was noted. Patients in the 6th decade of life were most affected. The following conditions-were more commonly related to FPE: neoplasias (20%) and heart failure (18.5%). The conditions most commonly misdiagnosed as FPE were pulmonary edema (16%), pneumonia (15%) and myocardial infarction (10%). The clinical diagnosis of FPE showed a sensitivity of 25.6%, a specificity of 97.9%, and an accuracy of 95.6%.


CONCLUSIONS
The diagnosis of pulmonary embolism made on clinical grounds still has considerable limitations.
Mesquita
C T
CT
Hospital Universitário Antônio Pedro, UFF, São Gonçalo, RJ, Brazil.
Morandi Júnior
J L
JL
Perrone
F T
FT
Oliveira
C da S
Cda S
Barreira
L J
LJ
Nascimento
S S
SS
Pareto Júnior
R C
RC
Mesquita
E T
ET
D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D003951:Diagnostic Errors; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity