The diagnosis of pulmonary embolism remains difficult. The objective of this study was to analyze the effect of age on the clinical presentation mode and the sensitivity of the diagnostic scores.
In retrospect, all patients discharged with a documented diagnosis of pulmonary embolism from the adult emergency service of the Regional university hospital of Strasbourg (France) over a year were considered. According to 4 age categories (<70, 70-74, 75-80 and >80 years) the data from the medical records were analyzed and compared. Diagnostic scores of Wells and modified Geneva were calculated.
117 patients met the inclusion criteria (mean age 71.8±13.8 years, women 54%). Chest pain was less common after 80 years; no difference was observed for syncope or dyspnea although the oxygen saturation is lower in old age. For diagnosis, 25% of patients had a lung scintigraphy with an increased recourse with age (<70 years: 10%, >80 years: 41%). Thoracic computed tomography angiography concerned 79% of patients with a significant decrease of his use in older. The sensitivity of the diagnostic scores was low but increased with age when the strong and intermediate probabilities of pulmonary embolism were combined.
This study confirms the low specificity of the clinical signs of pulmonary embolism, whatever the age. It also shows the low sensitivity of the diagnostic scores in the 70 years or older.