The clinical features and management of pulmonary embolism at Chris Hani Baragwanath Academic Hospital

BACKGROUND: Pulmonary embolism (PE) is the most common cause of preventable deaths in hospitalised patients. OBJECTIVES: To determine the prevalence and associated features of PE at Chris Hani Baragwanath Academic Hospital (CHBAH) over a period of one year. METHODS: A retrospective study was performed of patients with acute PE, as confirmed by computed tomography of the pulmonary arteries (CTPA). RESULTS: A total of 498 CTPAs were requested during the study period. PE was confirmed in 147 (30%) of these cases. The mean age of the patients with PE was 46.8 (15.5) years. More than 40% of the patients with PE were HIV positive, of whom more than 60% had a CD4 count <200 cells/µL. Wells’ and revised Geneva scores indicated comparable clinical probability of PE. Only 15% of the patients with highrisk PE were thrombolysed, with no documented complications. There were clear contraindications for thrombolysis in only two cases, but no reasons were stated for the other cases where thrombolysis was not utilised. None of the patients had a surgical or percutaneous embolectomy. A mortality rate of 24% was found among patients diagnosed with a PE; of these, 13 (46%) presented with high-risk PE and 2 were thrombolysed. Age >40 years was the only significant predictor of mortality, as indicated by both univariate and multivariate analyses. CONCLUSION: PE is a common medical condition at CHBAH. The heavy infectious disease burden in the South African setting makes the diagnosis of PE challenging. Its management needs further optimisation to improve clinical outcomes.