Department of Pulmonary Diseases, Gazi University School of Medicine, Ankara, Turkey.
Clin Appl Thromb Hemost. 2013 Jul-Aug;19(4):402-9. doi: 10.1177/1076029612440164. Epub 2012 Apr 11.
Pulmonary embolism (PE) is a common and serious disease that can result in death unless emergent diagnosis is made and treatment is initiated. In this study, we aimed to identify whether there is still a delay in the diagnosis of PE and to identify the time to delay in diagnosis and factors leading to this delay.
This is a prospective observational cohort study performed in an emergency department (ED) of a tertiary care university hospital between September 2008 and September 2010. The rate and cause of delay in diagnosis were analyzed among patients with PE. The "delay" was defined as diagnosing after first 24 hours of symptom onset.
Among the 53 patients who were diagnosed with PE, a delay in diagnosis was present in 49 (93%) of them. Total delay time was 6.8 ± 7.7 days. In 33 (62%) patients, there was a delay of 4.6 ± 6.5 days due to patient-related factors. Delay in diagnosis after admission to hospital was 2.2 ± 2.9 days in 40 (75%) patients. In multivariate regression analysis, being female and having chest pain and cough were identified as significant factors causing patient-related delay. Unilateral leg edema, recent operation, and previous venous thromboembolism (VTE) history were the significant factors causing PE diagnosis without a delay. On the other hand, systemic hypertension as comorbidity was the only factor leading to physician-related delay.
The delay in diagnosis of PE in EDs still remains as an important problem. While being female and having chest pain and cough are significantly and independently associated with patient delay in diagnosis, the unilateral leg edema, recent operation, and previous VTE history cause physicians to diagnose on time. On the other hand, having hypertension as comorbidity may lead to physician delay. In order to prevent the delay in diagnosis, hospital-associated factors must be elucidated totally and more interventions must be made to increase public and professional awareness of the disease.
肺栓塞（PE）是一种常见且严重的疾病，如果不能及时诊断和治疗，可能导致死亡。本研究旨在确定 PE 的诊断是否仍存在延迟，并确定诊断延迟的时间和导致这种延迟的因素。
这是一项在 2008 年 9 月至 2010 年 9 月期间在一家三级大学附属医院的急诊科进行的前瞻性观察性队列研究。分析了患有 PE 的患者的诊断延迟率和原因。“延迟”定义为症状出现后 24 小时内进行诊断。
在 53 例确诊为 PE 的患者中，49 例（93%）存在诊断延迟。总延迟时间为 6.8 ± 7.7 天。在 33 例（62%）患者中，由于患者相关因素导致延迟 4.6 ± 6.5 天。在 40 例（75%）患者中，入院后诊断延迟 2.2 ± 2.9 天。在多变量回归分析中，女性、胸痛和咳嗽被确定为导致患者相关延迟的显著因素。单侧腿部水肿、近期手术和既往静脉血栓栓塞（VTE）病史是导致无延迟诊断的显著因素。另一方面，作为合并症的系统性高血压是导致医生相关延迟的唯一因素。
急诊科 PE 的诊断延迟仍然是一个重要问题。虽然女性、胸痛和咳嗽与患者诊断延迟显著相关，但单侧腿部水肿、近期手术和既往 VTE 病史使医生能够及时诊断。另一方面，合并症高血压可能导致医生延迟诊断。为了防止诊断延迟，必须全面阐明医院相关因素，并采取更多干预措施提高公众和专业人员对该疾病的认识。
