Determinants and prognostic impact of diagnostic delay in pulmonary embolism

Abstract

Introduction: Clinical presentation of pulmonary embolism (PE) is not specific and can lead to delayed diagnosis. Little is known about the determinants and the prognostic impact of this delay.

Objectives: The aims of the study were to identify the determinants of the diagnostic delay and to evaluate its prognostic impact in patients with a first episode of PE.

Methods: We conducted a retrospective analysis of a monocentric prospective cohort of patients with a first episode of PE. The diagnostic delay was defined as the median time from first symptom onset to diagnosis (> 3 days). Multivariable logistic regression analysis was performed to identify independant determinants of diagnostic delay. Prognostic impact was measured as the occurence of a 30-day adverse event including all-cause mortality, haemodynamic collapse or recurrent PE.

Results: Among the 514 patients included, 240 (47%) had a diagnostic delay >3 days. Previous deep vein thrombosis (OR 0.56, 95%CI, 0.34-0.92), immobilization (OR 0.52, 95%CI, 0.29-0.92), surgery (OR 0.31, 95%CI, 0.16-0.60), chest pain (OR 0.55, 95%CI, 0.38-0.80), syncope (OR 0.43, 95%CI, 0.21-0.89), dyspnea (OR 2.39, 95%CI, 1.55-3.69) and hemoptysis (OR 3.67, 95%CI, 1.50-9.01) were independent risk factors for diagnostic delay. Twenty-two patients (4.3%, 95%CI, 2.8-6.5) had a 30-day complicated outcome: 15 patients (6.2%, 95%CI, 3.7-10.3) were in the diagnostic delay group and 7 (2.6%, 95%CI, 1.1-5.4) in the group without delay (p=0.039).

Conclusions: Diagnostic delay is associated with the absence of major risk factors for PE or clinical features such as chest pain or syncope, and the presence of dyspnea or hemoptysis. This delay was associated with a worse 30-day prognosis.