Walen S, Damoiseaux R A M J, van den Berg J W K
*Dit onderzoek werd eerder gepubliceerd in The British Journal of General Practice (2016;66:e444-50) met als titel 'Diagnostic delay of pulmonary embolism in primary and secondary care: a retrospective cohort study'. Afgedrukt met toestemming.
Ned Tijdschr Geneeskd. 2016;160:D840.
To quantify the different stages of diagnostic delay of pulmonary embolism (PE) in patients and to identify other clinical factors associated with this delay.
Case series.
Medical records were reviewed for all patients diagnosed with PE in the period 1 January 2008 and 31 December 2009 in Isala Hospital in Zwolle (the Netherlands), and data was collated for: the dates of symptom onset, presentation to a GP, referral to secondary care, and diagnosis respectively. The relationship between diagnostic delay and other clinical parameters such as gender, age, risk factors, symptoms and co-morbidities was tested using multivariate logistic regression analysis.
For the 261 patients included in the analysis, the average total delay was 8.6 days. Patient delay (4.2 days average) and delay in primary care (3.9 days) were the major contributors to this delay. Chest pain and symptoms of deep venous thrombosis were associated with an early diagnosis. Patient delay was shorter in patients with chest pain and longer in patients with dyspnoea. In primary care, chest pain and rales were associated with an early referral, whereas the presence of co-morbidity led to a delayed referral. Delay in secondary care was shorter when the patient presented with dyspnoea.
The diagnostic delay of PE is substantial, especially patient delay and delays originating in primary care. Further research is needed to identify clinical factors that raise suspicion of PE in primary care, to aid the development of improved diagnostic models.
量化患者肺栓塞（PE）诊断延迟的不同阶段，并确定与此延迟相关的其他临床因素。
病例系列研究。
回顾了2008年1月1日至2009年12月31日期间在荷兰兹沃勒的伊萨拉医院被诊断为PE的所有患者的病历，并分别整理了症状出现日期、就诊于全科医生的日期、转诊至二级医疗机构的日期以及诊断日期的数据。使用多因素逻辑回归分析检验诊断延迟与其他临床参数（如性别、年龄、危险因素、症状和合并症）之间的关系。
纳入分析的261例患者，平均总延迟为8.6天。患者延迟（平均4.2天）和初级医疗延迟（3.9天）是造成这种延迟的主要因素。胸痛和深静脉血栓形成症状与早期诊断相关。有胸痛的患者患者延迟较短，而有呼吸困难的患者患者延迟较长。在初级医疗中，胸痛和啰音与早期转诊相关，而合并症的存在导致转诊延迟。当患者出现呼吸困难时，二级医疗延迟较短。
PE的诊断延迟相当严重，尤其是患者延迟和初级医疗中的延迟。需要进一步研究以确定在初级医疗中提高对PE怀疑的临床因素，以帮助开发改进的诊断模型。
