Pulmonary embolism: differences in presentation between older and younger patients.

BACKGROUND the incidence of pulmonary embolism increases with age but the 'classical' presentation of acute pulmonary embolism may not occur in older persons. OBJECTIVES to compare the clinical presentation of younger and older patients with acute pulmonary embolism. DESIGN retrospective identification of 60 consecutive cases of spiral computed tomography confirmed acute pulmonary embolism over a 3-year period, with blinded review of radiological films and electrocardiographs, and analysis of clinical presentation. SETTING a district general hospital serving a population of 200,000 people. SUBJECTS 31 younger and 29 older patients with acute pulmonary embolism. RESULTS older persons less often complained of pleuritic chest pain (P < 0.02), particularly as their primary presenting complaint (P < 0.002). Twenty-four percent of older but just 3% of younger persons presented with collapse (P < 0.02), despite similar proportions of central and peripheral emboli in the two groups. Older persons were more often cyanosed (P = 0.05) and hypoxic (P < 0.04) than younger persons but there were no significant differences with respect to heart rate, respiratory rate or mean arterial blood pressure. CONCLUSIONS older people present atypically with acute pulmonary embolism, potentially leading to delays in diagnosis and initiation of treatment. Collapse is a particularly important symptom of acute pulmonary embolism in older persons, even in the absence of pain.