title: Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation.
abstract: OBJECTIVE
  Diagnosis of pulmonary embolism (PE) remains difficult and is often missed in the elderly due to nonspecific and atypical presentation. Diagnostic algorithms able to rule out PE and validated in young adult patients may have reduced applicability in elderly patients, which increases the number of diagnostic tools use and costs. The aim of the present study was to analyze the reported clinical presentation of PE in patients aged 65 and more.
  
  
  METHODS
  Prospective and retrospective English language studies dealing with the clinical, instrumental and laboratory aspects of PE in patients more than 65 and published after January 1987 and indexed in MEDLINE using keywords as pulmonary embolism, elderly, old, venous thromboembolism (VTE) in the title, abstract or text, were reviewed.
  
  
  RESULTS
  Dyspnea (range 59%-91.5%), tachypnea (46%-74%), tachycardia (29%-76%), and chest pain (26%-57%) represented the most common clinical symptoms and signs. Bed rest was the most frequent risk factor for VTE (15%-67%); deep vein thrombosis was detected in 15%-50% of cases. Sinus tachycardia, right bundle branch block, and ST-T abnormalities were the most frequent ECG findings. Abnormalities of chest X-ray varied (less than 50% in one-half of the studies and more than 70% in the other one-half). Arterial blood gas analysis revealed severe hypoxemia and mild hypocapnia as the main findings. D-Dimer was higher than cut-off in 100% of patients in 75% of studies. Clinical usefulness of D-Dimer measurement decreases with age, although the strategies based on D-Dimer seem to be cost-effective at least until 80 years.
  
  
  CONCLUSIONS
  Despite limitations due to pooling data of heterogeneous studies, our review could contribute to the knowledge of the presentation of PE in the elderly with its diagnostic difficulties. A diagnostic strategy based on reviewed data is proposed.
authors.affiliation: Internal Medicine, Cecina Hospital, Cecina, Italy. luca.masotti@tin.it
authors.forename: Luca
authors.initials: L
authors.lastname: Masotti
authors.forename: Patrick
authors.initials: P
authors.lastname: Ray
authors.forename: Marc
authors.initials: M
authors.lastname: Righini
authors.forename: Gregoire
authors.initials: G
authors.lastname: Le Gal
authors.forename: Fabio
authors.initials: F
authors.lastname: Antonelli
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Landini
authors.forename: Roberto
authors.initials: R
authors.lastname: Cappelli
authors.forename: Domenico
authors.initials: D
authors.lastname: Prisco
authors.forename: Paola
authors.initials: P
authors.lastname: Rottoli
mesh_terms: D000368:Aged; D000465:Algorithms; D001510:Bed Rest / Q000009:adverse effects; D001784:Blood Gas Analysis; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D