Eylem Sercan ÖZGÜR, Ahmet İLVAN, Cüneyt AYRIK, Seyran BOZKURT, İbrahim TOKER, Mehmet ÇELİKDEMİR, İbrahim ÇEVİK

Pulmoner embolide yanlış tanı ve sebepleri

Giriş: Pulmoner tromboembolide (PTE) zaman ında do ğru tan ı konularak erken tedavinin ba ş lanması hayati öneme sahiptir. Tan ı vetedavi gecikmesi mortaliteyi önemli oranda artıran en önemli nedenler olarak bilinmektedir. Bu nedenle bu çalışmada yanlış tan ı alanve sonrasında PTE tan ısı konulan hastaların demografik ve klinik verilerinin incelenmesi, yanlış tan ı almay ı etkileyen faktörlerin ortayaç ıkarılması amaçlanm ıştır.Materyal ve Metod: Gö ğüs hastalıkları kliniğine Ocak 2007-Ocak 2012 tarihleri arasında pulmoner emboli tan ısı ile acil servisten yatışverilen 100 PTE olgusunun dosyası retrospektif olarak de ğerlendirildi. İlk ba ş vuruda PTE dışında tan ı alanlar yanlış tanı alan grup(YTAG, n= 26), PTE tan ısı alanlar do ğru tan ı alan grup (DTAG, n= 74) olarak sın ıflandırıldı. Olguların demografik özellikleri, riskfaktörleri, klinik ve laboratuvar bulguları incelendi. Sonuçlar uygun istatistiksel yöntemlerle de ğerlendirildi.Bulgular: İki grup arasında fizik muayene ve laboratuvar bulguları aç ıs ından anlamlı bir fark bulunmadı. Tan ı alma süresi bir haftadanfazla olan olgularda yanlış tan ı oran ı fazla bulundu (p= 0.002). PTE ye ait herhangi bir risk faktörü olmayan olgularda yanlış tan ı oran ıfazla bulundu (p= 0.017). Kalp hastalığı olan olgularda ise yanlış tan ı oran ı daha az bulundu (p= 0.033). Bu olguları Geneva risksın ıflamasına göre de ğerlendirdiğimizde, klinik olas ılık arttıkça yanlış tan ın ın azaldığı gözlemlendi (p= 0.011).Sonuç: Geneva risk s ın ıflamasına göre dü ş ük risk sınıfında olanlarda, şikayetlerin ba şlama süresi bir haftadan fazla olanlarda, PTE yeait herhangi bir risk faktörü ve kalp hastalığı olmayan olgularda yanlış tan ı oran ı anlamlı olarak fazla bulundu. Bu parametreleredikkat edilmesinin PTE de yanlış tan ıları azaltabileceği düşünüldü.

Misdiagnosis of pulmonary embolism and causes

Pulmonary thromboembolism (PTE) is not only oneof the prevelant diseases with a high mortality risk but also has ahigh ratio of delayed diagnosis and misdiagnosis. In this study, itwas aimed to determine the demographical characteristics, riskfactors, clinical and laboratory findings of the patients that werediagnosed as PTE at their first hospital visit and of the PE patientswho were misdiagnosed at their first admission. We aimed to investigate the factors which can leads to misdiagnosis of PE, and todetermine the ways to avoid misdiagnosis.Materials and Methods: One hundred PTE patients who were admitted to University Hospital between the dates January2007-December 2011 were included in the study. Clinical and laboratory findings of these patients were evaluated. Among thesepatients, 26 were misdiagnosed at their first admission but diagnosed accurately (as PTE) in our hospital and 74 were diagnosedaccurately. Two groups were compared with respect to various data of the patients clinical and demographical characteristics.Results: Between the two groups, there was no difference in terms of physical examination and laboratory findings. The patients withthe symptoms onset was over a week ago had a higher misdiagnosis rate (p= 0.002). The patients with no risk of PTE had a highermisdiagnosis rate (p= 0.017). Misdiagnosis rate of the patients with cardiac diseases was lower (p= 0.033) According to Geneva riskscore, we observed that the misdiagnosis risk was reduced in the patients with higher clinical probability (p= 0.011).Conclusion: In conclusion, misdiagnosis rate was found to be statistically significant in the patients with low score according to theGeneva risk classification, and whose pre-diagnosis period lasted for more than a week and with no risk factors of PTE or cardiacdiseases. We are in the opinion that considering these parameters will help to reduce in misdiagnosis of pulmonary embolism cases.

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