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.