Delayed Diagnosis in Pulmonary Embolism: Frequency, Patient Characteristics, and Outcome.

Mansella, Gregory; Keil, Christoph; Nickel, Christian H; Eken, Ceylan; Wirth, Christian; Tzankov, Alexandar; Peterson, Caspar Joyce; Aujesky, Drahomir; Bingisser, Roland (2020). Delayed Diagnosis in Pulmonary Embolism: Frequency, Patient Characteristics, and Outcome. Respiration, 99(7), pp. 589-597. Karger 10.1159/000508396

Text Mansella, Respiration 2020.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (265kB)

BACKGROUND

The incidence and the outcomes of pulmonary embolism (PE) missed during emergency department (ED) workup are largely unknown.

OBJECTIVES

To describe the frequency, demographics, and outcomes of patients with delayed diagnosis of PE.

METHODS

We retrospectively compared patients diagnosed with PE during ED workup (early diagnosis) with patients diagnosed with PE thereafter (delayed diagnosis). Electronic health records (EHR) of 123,560 consecutive patients who attended a tertiary hospital ED were screened. Data were matched with radiology and pathology results from the EHR.

RESULTS

Of 1,119 patients presenting to the ED with early workup for PE, PE was diagnosed in 182 patients (80.5%) as early diagnosis. Delayed diagnosis was established in 44 cases (19.5%) using radiology and/or autopsy data. Median age of patients with early diagnosis was significantly lower as compared to delayed diagnosis (67 vs. 77.5 years). Main symptoms were dyspnea (109 patients [59.9%] in early, 20 patients [45.5%] in delayed diagnosis), chest pain (90 patients [49.5%] in early, 8 patients [18.2%] in delayed diagnosis), and nonspecific complaints (16 patients [8.8%] in early, 13 patients [29.5%] in delayed diagnosis). In-hospital mortality was 1.6% in early diagnosis and 43.2% in delayed diagnosis.

CONCLUSIONS

Delayed diagnosis of PE carries a worse prognosis than early diagnosis. This discrepancy may arise from either delayed therapy, confounding variables (e.g., older age), or both. Possible reasons for delayed diagnoses are nonspecific presentations and symptoms overlapping with preexisting conditions.

Interest & Impact

Downloads

1 since deposited on 25 Aug 2020
0 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item