PRETEST PROBABILITY AND FORECASTING LETHAL OUTLET FROM PULMONARY THROMBOEMBOLISM

Abstract

Pulmonary thromboembolism (PTE) is a syndrome`s component of vena cava superior and vena cava inferior thrombosis, so, in foreign literature it`s called venous thromboembolism. PTE is generally recognized as an international problem of practical medicine due to high lethal risk: it`s on the third place in the structure of mortality after myocardial infarction and cerebral stroke. PTE may remain asymptomatic, or its diagnosis may be an incidental finding. Currently, frequency of PTE detection is increasing thanks to modern diagnostic methods, but instrumental methods of examination with high diagnostic specificity not available for routine diagnosis in the reception rooms of medical institutions. Annually, 0.1% of the world population dies from the PTE. It is hard to judge the true frequency of this disease because of the asymptomatic course. According to different local authors, mortality due to lack of adequate treatment is about 40-50% of patients. Mortality among patients with PTE, receiving adequate treatment on time, is only 10%. Actuality of this problem, firstly, is associated with the age of population in the developed cities. Secondly, conditions of modern life predispose to the decrease of physical activity, that with dietary errors lead to metabolic disorders. Purpose of the study. Assess the pretest probability of pulmonary embolism and assess the possibility of predicting the lethal outcome and the actual mortality in PTE at hospital and in the delayed periods. Materials and methods. We researched case histories of 34 people who were treated in the clinics of the Military Medical Academy with a diagnosis of PTE as the primary or concomitant disease in the time period from March 2012 to October 2017. Conclusions. 1. At present, there is no reliable highly sensitive and specific method for diagnosing PTE. The presence of clinical symptoms even with low and intermediate pre-test clinical probability of PTE and negative blood test results to the D-dimer level requires CT angiography and/or lung scintigraphy, which indicates the need to improve the existing diagnostic algorithm. 2. The PESI scale provides indicative data on the 30-day mortality, however, with long-term follow-up, its predictive value is significantly reduced.