Pulmonary embolism in the nursing home population: high frequency at autopsy in female residents

Abstract Pathological and clinical findings of all consecutive autopsies performed at The Jewish Home and Hospital for Aged from 4/1/85 to 12/31/86 were reviewed to determine the frequency and clinical significance of pulmonary embolism as a cause of death in the nursing home. The autopsies were performed by a single pathologist and a diagnosis of pulmonary embolism (PE) was based on microscopic confirmation of macroscopic findings. All charts during this time period were reviewed for classic signs and symptoms of PE, presence of risk factors associated with PE, ambulatory status and rapidity of death. The autopsy rate during this period was 25.6%. Of 41 autopsies reviewed (31 females and 10 males) 14 cases of pulmonary embolism were found representing a prevalence of 34.1%. All occurred in females. Pulmonary infarction was present in four cases. Massive PE (interrupting blood flow to both lungs) and major PE (interrupting flow to one entire lung) made up 11 of the cases (26.8% of all autopsies). Classic symptoms were not more frequent premortem in those with PE than those without PE. The presence of risk factors, or rapid death, or bedbound state did not predict the presence of PE. In none of the cases was the diagnosis established premortem. Elderly female residents of chronic care facilities appear to be at special risk of death from pulmonary embolism. Clinical findings are not of a diagnostic nature.