Department of Emergency Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland,
Department of Cardiology, Vienna North Hospital, Vienna, Austria.
Respiration. 2020;99(7):589-597. doi: 10.1159/000508396. Epub 2020 Jul 21.
The incidence and the outcomes of pulmonary embolism (PE) missed during emergency department (ED) workup are largely unknown.
To describe the frequency, demographics, and outcomes of patients with delayed diagnosis of PE.
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.
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.
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.
在急诊科（ED）检查过程中漏诊的肺栓塞（PE）的发生率和结局在很大程度上是未知的。
描述延迟诊断 PE 的患者的频率、人口统计学特征和结局。
我们回顾性比较了在 ED 检查期间诊断为 PE（早期诊断）的患者和此后诊断为 PE（延迟诊断）的患者。筛选了 123560 例连续就诊于三级医院 ED 的患者的电子健康记录（EHR）。数据与 EHR 中的放射学和病理学结果相匹配。
在 1119 例因早期工作流程而在 ED 就诊的患者中，有 182 例（80.5%）诊断为 PE，为早期诊断。使用放射学和/或尸检数据确定了 44 例（19.5%）延迟诊断。早期诊断患者的中位年龄明显低于延迟诊断患者（67 岁 vs. 77.5 岁）。主要症状为呼吸困难（早期诊断 109 例[59.9%]，延迟诊断 20 例[45.5%]）、胸痛（早期诊断 90 例[49.5%]，延迟诊断 8 例[18.2%]）和非特异性症状（早期诊断 16 例[8.8%]，延迟诊断 13 例[29.5%]）。早期诊断的院内死亡率为 1.6%，延迟诊断的院内死亡率为 43.2%。
与早期诊断相比，PE 的延迟诊断预后更差。这种差异可能源于延迟治疗、混杂因素（例如，年龄较大）或两者兼而有之。延迟诊断的可能原因是非特异性表现和与原有疾病重叠的症状。
