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Concordance between clinical diagnosis of pulmonary thromboembolism at hospital discharge and anatomopathological diagnosis.
International Journal of Immunopathology and Pharmacology ( IF 3.5 ) Pub Date : 2020-08-24 , DOI: 10.1177/2058738420942390
Benjamín Rubio-Jurado 1, 2, 3 , Rocío Concepción Albores-Arguijo 2 , Antonio Guerra-Soto 2 , Teresita Plasencia-Ortiz 4 , Gerónimo Tavarez-Macías 4 , Jennifer Huerta-Hernández 4 , Carlos Riebeling-Navarro 5 , Arnulfo Hernán Nava-Zavala 2, 6, 7
Affiliation  

Half of the cases of pulmonary thromboembolism (PTE) are not diagnosed because of its unspecific clinical presentation; in Mexico, autopsy data reveal a similar incidence to that of developed countries. The objective of this work was to know the concordance between the clinical diagnosis of PTE at hospital discharge and its autopsy diagnosis. The method used was a retrospective cohort study of cases with PTE diagnosis who attended from January 2005 to December 2013. Information was obtained from the autopsies registry and clinical charts. From 177,368 hospital discharges, there were 412 (6.74%) with PTE diagnosis. There were 13,559 deaths, with PTE diagnosis in 139 (1%) patients. There were 479 autopsies, and in 66 (14%) of whom PTE diagnosis was documented, the mean age was 55 years (range, 18–89 years). The premortem diagnosis of PTE at discharge was confirmed in 412 cases. Postmortem diagnosis of principal disease was medical in 49 (74%) and medical-surgical in 17 (26%) patients. We found that nine patients had the clinical diagnosis of PTE, unlike the postmortem diagnosis, which was reported in 66 autopsies. The above allows establishing a 1:7 ratio that represents 14%. D-dimer was determined in 11 cases (16%) and was positive in 8 (73%). Thromboprophylaxis was applied in 15 cases (23%). The study of necropsies and identification of discrepancies is needed to improve the diagnostic accuracy and healthcare quality. The evaluation of hemostasis biomarkers besides D-dimer can better describe the pro-thrombotic state, the risk of thrombosis, and its association with morbidity and mortality.



中文翻译:

出院时肺血栓栓塞的临床诊断与解剖病理学诊断之间的一致性。

一半的肺血栓栓塞症(PTE)因其临床表现不明确而未被诊断;在墨西哥,尸检数据显示出与发达国家相似的发病率。这项工作的目的是了解出院时PTE的临床诊断与尸检诊断之间的一致性。使用的方法是对2005年1月至2013年12月就诊的PTE诊断病例进行的回顾性队列研究。信息来自尸体解剖登记处和临床图表。从177,368例出院患者中,有412例(6.74%)被诊断为PTE。139例患者中有13559例死亡,诊断为PTE(1%)。有479例尸检,有66例(14%)记录有PTE诊断,平均年龄为55岁(18-89岁)。412例确诊出院时PTE的死前诊断。死后诊断为主要疾病的有49名(74%)内科患者,17例(26%)内科患者为外科手术。我们发现有9名患者进行了PTE的临床诊断,这与验尸诊断不同,后者在66例尸检中报告。上述允许建立代表14%的1:7比率。确定D-二聚体11例(16%),阳性8例(73%)。15例(23%)进行了血栓预防。为了提高诊断准确性和医疗质量,需要进行尸检和差异鉴定的研究。除D-二聚体外,止血生物标志物的评估可以更好地描述血栓形成前的状态,血栓形成的风险及其与发病率和死亡率的关系。死后诊断为主要疾病的有49名(74%)内科患者,17例(26%)内科患者为外科手术。我们发现有9名患者进行过PTE的临床诊断,与验尸诊断不同,后者在66例尸检中报告。上述允许建立代表14%的1:7比率。确定D-二聚体11例(16%),阳性8例(73%)。15例(23%)进行了血栓预防。为了提高诊断准确性和医疗质量,需要进行尸检和差异鉴定的研究。除D-二聚体外,止血生物标志物的评估可以更好地描述血栓形成前状态,血栓形成的风险及其与发病率和死亡率的关系。死后诊断为主要疾病的有49位(74%)为医疗,17位(26%)为外科手术。我们发现有9名患者进行过PTE的临床诊断,与验尸诊断不同,后者在66例尸检中报告。上述允许建立代表14%的1:7比率。确定D-二聚体11例(16%),阳性8例(73%)。15例(23%)进行了血栓预防。为了提高诊断准确性和医疗质量,需要进行尸检和差异鉴定的研究。除D-二聚体外,止血生物标志物的评估可以更好地描述血栓形成前的状态,血栓形成的风险及其与发病率和死亡率的关系。我们发现有9名患者进行了PTE的临床诊断,这与验尸诊断不同,后者在66例尸检中报告。上述允许建立代表14%的1:7比率。确定D-二聚体11例(16%),阳性8例(73%)。15例(23%)进行了血栓预防。为了提高诊断准确性和医疗质量,需要进行尸检和差异鉴定的研究。除D-二聚体外,止血生物标志物的评估可以更好地描述血栓形成前的状态,血栓形成的风险及其与发病率和死亡率的关系。我们发现有9名患者进行了PTE的临床诊断,这与验尸诊断不同,后者在66例尸检中报告。上述允许建立代表14%的1:7比率。确定D-二聚体11例(16%),阳性8例(73%)。15例(23%)进行了血栓预防。为了提高诊断准确性和医疗质量,需要进行尸检和差异鉴定的研究。除D-二聚体外,止血生物标志物的评估可以更好地描述血栓形成前的状态,血栓形成的风险及其与发病率和死亡率的关系。15例(23%)进行了血栓预防。为了提高诊断准确性和医疗质量,需要进行尸检和差异鉴定的研究。除D-二聚体外,止血生物标志物的评估可以更好地描述血栓形成前的状态,血栓形成的风险及其与发病率和死亡率的关系。15例(23%)进行了血栓预防。需要进行尸检和差异鉴定研究以提高诊断准确性和医疗质量。除D-二聚体外,止血生物标志物的评估可以更好地描述血栓形成前状态,血栓形成的风险及其与发病率和死亡率的关系。

更新日期:2020-08-25
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