The role of risk factors in delayed diagnosis of pulmonary embolism

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. Crown Copyright (C) 2011 Published by Elsevier Inc. All rights reserved.