Risk factors associated with delayed diagnosis of acute pulmonary embolism

Sean B. Smith, Jeffrey B. Geske, Timothy Ian Morgenthaler

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Prompt diagnosis and treatment of acute pulmonary embolism (PE) is essential to reduce mortality. Risk factors for PE are well known, but factors associated with delayed diagnosis are less clear. Objective: Our objective was to identify clinical factors associated with delayed diagnosis of patients with acute PE presenting to a tertiary-care emergency department (ED). Methods: We studied 400 consecutive adults who presented to our ED with acute, symptomatic PE. All patients were diagnosed by computed tomography (CT) angiography. Early diagnosis was defined as CT diagnosis < 12 h from ED arrival, and delayed diagnosis as CT diagnosis > 12 h. Univariate and multiple logistic regression models were used to identify factors associated with delayed diagnosis. Odds ratios with 95% confidence intervals are reported. Results: The median time from arrival to diagnosis was 2.4 h (interquartile range 1.47.6), and 73 (18.3%) patients had delayed diagnosis. Patients aged > 65 years and those with coronary artery disease or congestive heart failure had longer times from ED arrival to CT diagnosis, whereas patients with recent immobility had shorter times. Patients diagnosed > 12 h were older and had higher rates of morbid obesity and coronary artery disease, whereas patients diagnosed < 12 h had higher rates of tachycardia. In multiple regression modeling, tachycardia and recent immobility remained associated with early diagnosis, whereas morbid obesity remained associated with delayed diagnosis. Conclusions: Older patients with cardiovascular comorbidities had longer times from ED arrival to CT diagnosis. Our data suggest that these patients represent more of a diagnostic challenge than those presenting with traditional risk factors for PE, such as tachycardia and recent immobilization. Physicians should consider these factors to diagnosis acute PE promptly in the ED.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalJournal of Emergency Medicine
Volume42
Issue number1
DOIs
StatePublished - Jan 2012

Fingerprint

Delayed Diagnosis
Pulmonary Embolism
Hospital Emergency Service
Tachycardia
Morbid Obesity
Tomography
Coronary Artery Disease
Early Diagnosis
Logistic Models
Tertiary Healthcare
Immobilization
Comorbidity
Heart Failure
Odds Ratio
Confidence Intervals
Physicians
Mortality

Keywords

  • delay
  • diagnosis
  • pulmonary embolism
  • risk factors
  • timing

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Risk factors associated with delayed diagnosis of acute pulmonary embolism. / Smith, Sean B.; Geske, Jeffrey B.; Morgenthaler, Timothy Ian.

In: Journal of Emergency Medicine, Vol. 42, No. 1, 01.2012, p. 1-6.

Research output: Contribution to journalArticle

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