Background:
Acute pulmonary embolism (PE) is a common and frequently fatal disease. Mortality could be reduced by early diagnosis and management. The clinical presentation of PE is variable and nonspecific and thus the diagnostic delay is common. However, few studies have investigated factors associated with delayed diagnosis of PE in the emergency department.
Methods:
Data on patients with PE were collected from January 2011 to June 2013 in our hospital. Time‐to‐event (taking CT) analysis was used for factors associated with time to PE diagnosis by Cox proportional hazard model. Independent variables included age, gender, daytime arrival, attending by an emergency department physician, cared by residents, referred patients, typical symptoms, body temperature, heart rate, respiratory rate, hypoxemia, C‐reactive protein, chest X‐ray infiltration, Well’s score, activities of daily living, and severity.
Results:
In a total of 57 patients (Mean age 71; 15 men), the median time to PE diagnosis was 156 minutes (range, 17 minutes‐432 hours). The time to diagnose was significantly influenced for earlier diagnosis in referred patients from other hospitals/clinics (hazard ratio, 0.4; 95% CI 0.2‐0.9) and those with higher Well’s score (hazard ratio, 0.7; 95% CI 0.6‐0.9), but for delayed diagnosis by higher C‐reactive protein concentrations (hazard ratio, 1.1; 95% CI 1.0‐1.3).
Conclusions:
The time to PE diagnosis is delayed in PE patients with lower Well’s score and those with higher C‐reactive protein concentrations.