The role of risk factors in delayed diagnosis of pulmonary embolism
Received 13 April 2009; received in revised form 9 July 2009; accepted 10 July 2009. published online 10 March 2010. Corrected Proof
Abstract
Background
Despite diagnostic advances, delays in the diagnosis of pulmonary embolism (PE) are common.
Objective
In this study, we aimed to investigate the relationship between delays in the diagnosis of PE and underlying risk factors for PE.
Methods
We retrospectively evaluated the records of 408 patients with acute PE. Patients were divided into 2 groups, surgical or medical, based on risk factors leading to the embolism. Analysis involved demographic characteristics of the patients, dates of symptom onset, first medical evaluation, and confirmatory diagnostic tests. Diagnostic delay was described as diagnosis of PE more than 1 week after symptom onset.
Results
The mean time to diagnosis for all patients was 6.95 ± 8.5 days (median, 3 days; range, 0-45 days). Of the total number of patients, 29.6% had presented within the first 24 hours and 72.3% within the first week. The mean time to diagnosis was 4.4 ± 7.6 days (median, 2 days; range, 0-45 days) in the surgical group and 8.0 ± 8.6 days (median, 4 days; range, 0-45 days) in the medical group (P = .000). The mean time to diagnosis in the medical group was approximately 4 times greater than that of the surgical group on univariate analysis. Early or delayed diagnosis had no significant impact on mortality in either group.
Conclusion
Delay in the diagnosis of PE is an important issue, particularly in medical patients. We suggest that a public health and educational initiative is needed to improve efficiency in PE diagnosis.
aDepartment of Chest Diseases, Karadeniz Technical University, School of Medicine, Trabzon, Turkey
bDepartment of Public Health, Karadeniz Technical University, School of Medicine, Trabzon, Turkey
cDepartment of Radiology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey
Correspondence author. Karadeniz Technical University, School of Medicine, Department of Chest Diseases, 61080, Trabzon, Turkey. Tel.: +90 462 3775407/+90 542 2374775; fax: +90 462 3257031.
ABSTRACT