Pulmonary embolism: differences in presentation between older and younger patients.
BACKGROUND
the incidence of pulmonary embolism increases with age but the 'classical' presentation of acute pulmonary embolism may not occur in older persons.


OBJECTIVE
to compare the clinical presentation of younger and older patients with acute pulmonary embolism.


METHODS
retrospective identification of 60 consecutive cases of spiral computed tomography confirmed acute pulmonary embolism over a 3-year period, with blinded review of radiological films and electrocardiographs, and analysis of clinical presentation.


METHODS
a district general hospital serving a population of 200,000 people.


METHODS
31 younger and 29 older patients with acute pulmonary embolism.


RESULTS
older persons less often complained of pleuritic chest pain (P < 0.02), particularly as their primary presenting complaint (P < 0.002). Twenty-four percent of older but just 3% of younger persons presented with collapse (P < 0.02), despite similar proportions of central and peripheral emboli in the two groups. Older persons were more often cyanosed (P = 0.05) and hypoxic (P < 0.04) than younger persons but there were no significant differences with respect to heart rate, respiratory rate or mean arterial blood pressure.


CONCLUSIONS
older people present atypically with acute pulmonary embolism, potentially leading to delays in diagnosis and initiation of treatment. Collapse is a particularly important symptom of acute pulmonary embolism in older persons, even in the absence of pain.
Department of Geriatric Medicine, Tralee General Hospital, Tralee, Co. Kerry, Ireland. suzannetimmons@hotmail.com
Suzanne
S
Timmons
Maeve
M
Kingston
Mehboob
M
Hussain
Hiliary
H
Kelly
Richard
R
Liston
D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002637:Chest Pain / Q000209:etiology; D003490:Cyanosis / Q000209:etiology; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007494:Ireland; D008297:Male; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D013575:Syncope / Q000209:etiology; D036542:Tomography, Spiral Computed