title: Fatal pulmonary embolism update: 10 years of autopsy experience at an academic medical center.
abstract: OBJECTIVE
  To investigate the rate of death caused by pulmonary embolism (PE) and the antemortem performance in diagnosis and treatment of PE.
  
  
  METHODS
  A systematic search of cases involving fatal PE via PowerPath® (Sunquest) followed by chart review.
  
  
  METHODS
  An academic medical centre located in San Diego, United States of America.
  
  
  METHODS
  Postmortem cases with pathological findings of PE.
  
  
  METHODS
  After data collection and collation, the data were subject to analysis.
  
  
  RESULTS
  From 2002 to 2012, PE was identified as the mechanism of death in 108 of 982 cases (11%, 95% CI 9.01-12.99%) at an institution with an average autopsy rate of 30% ± 0.07%. Excluding cases where care was withheld (by advance directive) or unavailable, 29 of 108 were eligible for antemortem treatment for PE. In 31% (nine of 29) of these cases the diagnosis of PE was considered antemortem. Only three of 29 were given thrombolytics despite only one case being contraindicated.
  
  
  CONCLUSIONS
  The rate of PE-related death is consistent with most other autopsy series and major epidemiologic studies despite advances in system wide deep venous thrombosis prophylaxis. The results validate previous studies that this diagnosis is often missed but probably improving compared to historical standards. Even when the diagnosis is considered, however, thrombolytics are not routinely given, even without contraindications. The cause of this failure to treat may require further study with comparison to patients that were treated to determine the utilization of this treatment. It also underscores the continued difficulty in the diagnosis of this disease.
authors.affiliation: Department of Pathology, University of California San Diego, San Diego, CA, USA.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Sweet
authors.forename: Theodore
authors.initials: T
authors.lastname: Armstrong
authors.forename: John
authors.initials: J
authors.lastname: Chen
authors.forename: Eliezer
authors.initials: E
authors.lastname: Masliah
authors.forename: Peter
authors.initials: P
authors.lastname: Witucki
references.citation: Chest. 2001 Sep;120(3):791-5
references.pmid: 11555511
references.citation: Crit Care Clin. 2011 Oct;27(4):953-67, vii-viii
references.pmid: 22082522
references.citation: PLoS One. 2009 Dec 15;4(12):e8323
references.pmid: 20016808
references.citation: Korean J Intern Med. 2009 Jun;24(2):123-7
references.pmid: 19543490
references.citation: J R Soc Med. 1989 Apr;82(4):203-5
references.pmid: 2716016
references.citation: Anaesth Intensive Care. 2011 Nov;39(6):1086-92
references.pmid: 22165363
references.citation: J Clin Pathol. 2004 Dec;57(12):1254-7
references.pmid: 15563663
references.citation: J R Soc Med. 2011 Aug;104(8):327-31
references.pmid: 21816931
references.citation: Circulation. 2010 Nov 2;122(18 Suppl 3):S729-67
references.pmid: 20956224
references.citation: J Clin Pathol. 1997 Jul;50(7):609-10
references.pmid: 9306945
references.citation: Circulation. 2004 Aug 10;110(6):744-9
references.pmid: 15262836
references.citation: N Engl J Med. 2002 Oct 10;347(15):1143-50
references.pmid: 12374874
references.citation: Thromb Haemost. 2007 Oct;98(4):756-64
references.pmid: 17938798
references.citation: Arch Intern Med. 1991 May;151(5):933-8
references.pmid: 2025141