Factors associated with a delayed diagnosis of pulmonary embolism
-
Sho Nishiguchi
,
Haruka Inada
Abstract
Background: Acute pulmonary embolism (PE) is frequently a fatal disease. The clinical presentation of PE is variable and frequently nonspecific, and there is commonly a diagnostic delay. We aimed to investigate factors associated with the delay in the diagnosis of PE.
Methods: Data from patients with PE were collected from January 2011 to December 2013 in an acute care teaching hospital. Time-to-diagnosis, evaluated by obtaining a diagnostic computed tomography scan, was then analyzed by the Cox proportional hazard model for examining factors associated with time to the diagnosis of PE. Independent variables included age, gender, activities of daily living, means of transport to the hospital, body temperature, hypoxemia, typical symptoms for PE, serum C-reactive protein (CRP) concentrations, infiltration on chest radiograph, Wells score, classification of patients with PE based on early mortality risk, patients referred from other specialties, daytime versus nighttime arrival, diagnosed by an emergency physician, and diagnosed by a medical resident.
Results: Sixty patients were included. The time to diagnosis was significantly delayed in low-risk patients (hazard ratio [HR], 2.2; 95% CI, 1.2–4.1) and in patients who did not use an ambulance (HR, 1.9; 95% CI, 1.0–3.7). In an analysis of the latter subgroup, higher serum CRP concentrations were associated with a delayed diagnosis (HR, 1.1; 95% CI, 1.0–1.2).
Conclusion: The time to the diagnosis of PE was delayed in low-risk patients and in patients who attended the hospital by means other than an ambulance. In such patients, a delayed diagnosis was associated with higher serum CRP concentrations.
Author contributions: All authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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©2016 by De Gruyter
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Articles in the same Issue
- Frontmatter
- Guidelines and Recommendations
- Methodologies for evaluating strategies to reduce diagnostic error: report from the research summit at the 7th International Diagnostic Error in Medicine Conference
- Mini Review
- Evaluation of DSM-5 and IWG-2 criteria for the diagnosis of Alzheimer’s disease and dementia with Lewy bodies
- Opinion Paper
- The Choosing Wisely campaign – don’t throw the baby out with the bathwater
- Original Articles
- Online public reactions to frequency of diagnostic errors in US outpatient care
- Disagreement between emergency department admission diagnosis and hospital discharge diagnosis: mortality and morbidity
- Is Ara h 2 indeed the best predictor for peanut allergy in Dutch children?
- Factors associated with a delayed diagnosis of pulmonary embolism
