Differences in clinical presentation of pulmonary embolism in older vs younger patients.
BACKGROUND
In order to better define the clinical characterization of pulmonary embolism (PE) in the elderly, the clinical and laboratory findings were compared in older (> or = 65 years old) and younger (< 65 years old) patients.


RESULTS
The study group comprised 149 patients (58 older and 91 younger) who received a final diagnosis of PE and were retrospectively evaluated. The severity of PE was assessed by calculating the pulmonary vascular obstruction scores (PVOs) scintigraphically: PVOs > or = 50% was defined as severe disease. Dyspnea was the most frequent symptom in both groups. Chest pain and hemoptysis were less frequent in older patients (48.3% vs 79.1%, p = 0.001; 6.9% vs 20.9%, p = 0.021, respectively) whereas syncope occurred more often in the older group (27.6% vs 9.9%, p = 0.005). PVOs > or = 50% occurred in 55.1% of older and 32.9% of younger patients (odds ratio: 1.67, 95%confidence interval: 1.118-2.507, p = 0.013).


CONCLUSIONS
The clinical presentation of PE can be subtle or atypical in elderly patients and hence they may have more severe disease. Therefore, a high clinical suspicion is required in order to prevent delays in diagnostic work-up and initiation of appropriate treatment.
Kokturk
Nurdan
N
Department of Pulmonary Medicine, Gazi University School of Medicine, Ankara, Turkey. nkokturk@gazi.edu.tr
Oguzulgen
I Kivilcim
IK
Demir
Nalan
N
Demirel
Koray
K
Ekim
Numan
N
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004417:Dyspnea / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D011877:Radionuclide Imaging; D012189:Retrospective Studies