Incidence, clinical characteristics, and long-term prognosis of travel-associated pulmonary embolism.
ABSTRACT Prolonged air travel is considered a risk factor for pulmonary embolism (PE). The clinical characteristics as well as the long-term prognosis of patients suffering from travel-associated PE ('economy-class syndrome', ECS) remain largely unknown. Owing to its proximity, our hospital is the primary referral centre for Frankfurt Airport, Europe's third-largest airport. The goal of our study was to follow-up all patients with ECS, who were admitted to our hospital between 1997 and 2006.
We systematically reviewed all medical charts from patients presenting with acute PE to our emergency room or intensive care unit (ICU) and performed a telephone follow-up on patients discharged alive. Together with the data provided from the statistics department of Fraport Inc., the operating company of the Frankfurt International Airport, we were also able to put the medical data in context with the corresponding number of passengers and flight distances. A total of 257 patients with acute PE were admitted to our emergency and ICU between 1997 and 2006. Out of these, 62 patients suffered from ECS (45 flight-associated PE and 17 from other travel-associated PE). ECS patients were prone to more haemodynamic relevant acute events, reflected by a higher rate of initial cardiopulmonary resuscitation (4.8% vs. 1.5%; P = 0.153) and higher percentage of massive PE (8% vs. 3%; P = 0.064). Nevertheless, intrahospital mortality was similar in both groups (ECS 4.8%, others 4.1%; P = 0.730). Interestingly, the long-term outcome of ECS patients was excellent (Kaplan-Meier analysis; P log-rank: 0.008 vs. other entities). In general, ECS was a rare event (one event/5 million passengers), where long-haul flights over 5000 km lead to a 17-fold risk increase compared with shorter flights.
Travel-associated PE was a common cause of PE in our hospital, with patients showing excellent long-term prognosis after discharge. The risk of ECS is rather low and strictly dependent on the flight distance.
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ABSTRACT: In patients following acute pulmonary embolism, little is known about long-term prognosis attributed to individual risk factors and entities of pulmonary embolism. The aim of our study was to identify predictors of long-term mortality and morbidity, taking into account precipitating causes and entities of pulmonary embolism, especially in cases of idiopathic pulmonary embolism. We reviewed the records of 257 consecutive patients presenting with acute pulmonary embolism in the emergency room of the University Hospital in Frankfurt between 1997 and 2006. The median of the follow-up time in this study population was 670 days (n = 236; interquartile range: 378-1397 days). The patients were divided into three groups depending on the cause of pulmonary embolism: idiopathic pulmonary embolism (n = 83; 33%), neoplasm (n = 44; 17%) and other causes (n = 130; 50%). As expected, patients with neoplastic-associated pulmonary embolism demonstrated the poorest prognosis in the Kaplan-Meier analysis. Surprisingly though, patients with idiopathic pulmonary embolism demonstrated a markedly worse long-term survival compared with other causes (log-rank P < 0.001). When Cox-regression analysis was restricted to patients discharged alive without neoplasm, idiopathic pulmonary embolism was the strongest predictor of long-term mortality (hazard ratio: 3.29; P = 0.017). Patients with acute pulmonary embolism and known malignancy demonstrated the highest mortality compared with those with other causes. However, idiopathic pulmonary embolism is a common diagnosis and is associated with an unfavorable long-term prognosis compared with other entities of pulmonary embolism.Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis 10/2009; 21(1):70-6. · 1.25 Impact Factor
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ABSTRACT: This article summarises the key points from the 2011 British Thoracic Society (BTS) recommendations on managing passengers with respiratory disease planning air travel. The guidance aims to provide practical advice for respiratory specialists in secondary care and serves as a valuable reference for other healthcare professionals managing these patients. A greater awareness of the challenges posed by air travel will allow improved clinical assessment and practical advice to encourage patients to fly safely wherever possible.Thorax 09/2011; 66 Suppl 1:i1-30. · 8.38 Impact Factor