Pulmonary embolism (PE) is one of the venous thromboembolism (VTE) complexes side by side with deep vein thrombosis (DVT) that warrants immediate attention from vascular medicine specialist.1 It is considered as a major health problem in the US from an epidemiology review by Heit.2 It is also one of the most common cause of preventable in-hospital mortality in the United States; in the European Union, a report by Cohen et al suggest that about 75% of deaths by VTE was hospital acquired.3 According to Dasta et al, cost of treatment for pulmonary embolism is was highest during the first 3 days (>6500USD).4 Diagnostic is likewise costly if it is available.
Wells et al. proposed a scoring system to improve the diagnostic accuracy of PE,5 although, in itself can not totally rule out nor rule in PE, it can help interpretation of subsequent diagnostic and reduce the need of additional invasive testing. Scoring system such as the pulmonary embolism rule-out criteria (PERC) was proposed by Kline et al were patients with low pre-test probability of PE who meet any of its criteria, further test can be considered to rule out PE; for PERC negative on the other hand, PE likelihood is very low (<2%).6 Once PE has been established, Pulmonary embolism severity index score (PESI) has been utilized to prognosticate patient in their outcome.
Locally, a report in this institution of 45 consecutive patients by Cantre et al had 28% all-cause mortality; noted however at the time, a detailed diagnosis nor confirmed presence of PE was not reported on all cases.7 Treatment choice of systemic thrombolysis was not yet widely available hence, no thrombolysis was initiated to any patient.
This study is a review of patient diagnosed with pulmonary embolism at the time of admission or during the course admission from January to December of 2016, clinical profile and intervention were reviewed.