ACİL SERVİSTE PULMONER TROMBOEMBOLİ ŞÜPHESİ İLE TETKİK EDİLEN HASTALARIN BAŞVURU VİTAL BULGULARININ KESİN TANIYA KATKISI

Abstract

Sağlam H.C., The Contribution of Admission Vital Signs to the Definitive Diagnosis in Patients Presenting to the Emergency Department with Suspected Pulmonary Thromboembolism, Hacettepe University Faculty of Medicine, Department of Emergency Medicine, Specialty Thesis, Ankara, 2026. Introduction and Aim: Pulmonary thromboembolism (PTE) is a high-mortality emergency that is difficult to diagnose because of its nonspecific clinical presentation. Data on the contribution of vital signs measured at admission to the definitive diagnosis are limited. This study aimed to determine the contribution of admission vital signs to the definitive diagnosis of PTE and their association with mortality in patients presenting to the emergency department with suspected PTE. Materials and Methods: This prospective observational study was conducted in the Emergency Department of Hacettepe University Hospital. A total of 1,582 patients aged 18 years and older who underwent contrast-enhanced thoracic computed tomography angiography (CTPA) or ventilation/perfusion (V/Q) scintigraphy with a presumptive diagnosis of PTE between July 1, 2024, and October 1, 2025, were included in the study. Results: Of the 1,582 patients included, 48.5% were female and 51.5% were male, with a median age of 66 years (IQR: 23). PTE was diagnosed in 300 patients (19%), with segmental-level PTE being the most frequent (9.5%). In PTE-positive patients, median systolic and diastolic blood pressures were significantly lower (121.5 vs. 128 mmHg, p<0.001, and 76 vs. 79 mmHg, p=0.001, respectively), heart rate (110 vs. 95 beats/min, p<0.001) and respiratory rate (24 vs. 20 breaths/min, p<0.001) were significantly higher, and oxygen saturation was lower (91% vs. 94%, p<0.001). No significant difference was observed between the groups with respect to body temperature (p=0.585). In the diagnostic performance analysis, respiratory rate achieved the highest sensitivity (0.790), whereas heart rate achieved the highest negative predictive value (0.895). Hypotension, tachycardia, tachypnea, and hypoxemia were significantly associated with mortality; body temperature did not predict mortality at any time point. Conclusion: In patients presenting to the emergency department with suspected PTE, admission vital signs—with the exception of body temperature—contribute significantly both to establishing the definitive diagnosis and to predicting short- and intermediate-term mortality. Nevertheless, no single vital parameter possesses adequate diagnostic performance on its own; therefore, vital signs should be used in integration with clinical decision support systems, laboratory tests, and imaging methods.