Diagnóstico y estratificación de riesgo de muerte temprana en tromboembolismo pulmonar agudo. Una revisión de la literatura

Diagnosis and early death risk stratification in acute pulmonary embolism. A review of the literature

Abstract

Background: Pulmonary Embolism (PE) is a pathology of great incidence and high mortality and morbidity. Given its variable presentation, acute PE diagnosis needs a high clinical suspicion complemented by the use of clinical prediction rules, nevertheless, imagenologic testing continues to be indispensable. Risk stratification is crucial to determine clinical course and prognosis of the patient.

Objective: To collect updated information about diagnosis and early death risk stratification in patients with acute PE.

Results: For a correct initial approach of acute PE, it is necessary to establish adequate behaviors in its diagnosis and risk stratification of early death. The diagnosis of this disease requires a high clinical suspicion associated with the use of pretest clinical probability scores, which will provide support for different diagnostic tests, being chest angiography the gold standard. Once the diagnosis is done, the patient should be stratified according to their risk of early death, which is mainly given by right ventricular dysfunction, associated with clinical, laboratory, imaging parameters, aggravating conditions and patient comorbidities. Early death risk stratification will support the choice of therapeutic strategy for each patient.

Conclusions: The unspecificity of PE clinical presentation and its high morbidity and mortality make initial recognition difficult, given this, it is fundamental that the health care team is fully qualified for its diagnosis, risk stratification and subsequent therapeutic management. A quick and coordinated multidisciplinary approach to this pathology is essential in the health care team.