Key result
Delayed pulmonary embolism diagnosis did not significantly increase mortality risk compared to timely diagnosis (adjusted HR 1.215; 95% CI 0.762-1.939; P=0.413).
Why the study?
Earlier studies showed increased mortality risk from delayed PE diagnosis, prompting investigation into the predictors of diagnostic delays and their effect on mortality.
Does delayed pulmonary embolism diagnosis increase mortality in patients admitted with pulmonary embolism?
Cohort (n=756)
Does delayed pulmonary embolism diagnosis increase mortality in patients admitted with pulmonary embolism?
Delayed diagnosis of pulmonary embolism is predicted by factors such as heart failure and precordial T wave inversions, but it does not significantly increase overall mortality.
Delayed PE diagnosis was not linked to higher mortality in this cohort; hypothesis-generating and should not yet change practice.
Background: Some earlier studies demonstrated an increased mortality risk attributed to delayed pulmonary embolism (PE) diagnosis. Therefore, we mainly aimed to determine the predictors of diagnostic delays and the effect of delayed diagnosis on mortality. Methods: We prospectively studied 756 consecutive patients admitted with PE between March 2007 and September 2017. The delayed diagnosis was defined as (1) patient presenting > 7 days after onset of symptoms, (2) diagnosis takes > 24 hours upon arriving in the ED, or (3) undergoing coronary angiography before establishing PE diagnosis. Results: A total of 127 (16.7%) patients met the delayed group's criteria. Heart failure (OR= 2.257, 95% CI: 1.130-4.508, P= 0.021), diabetes mellitus (OR= 1.568, 95% CI: 0.996-2.469, P= 0.052), and precordial T wave inversions (OR=2.559, 95% CI: 1.649-3.970, P< 0.001) were linked to higher rates of delayed diagnosis, while hemoptysis (OR=0.254, 95% CI: 0.059-1.087, P= 0.065) and hemodynamic instability (OR= 0.434, 95% CI: 0.168-1.123, P= 0.085) negatively correlated with it. Delayed PE diagnosis did not significantly impact the overall survival during the follow-up. The unadjusted and adjusted mortality hazard ratio for delayed diagnosis were 1.198 (95% CI: 0.758- 1.894, P= 0.439) and 1.215 (95% CI: 0.762- 1.939, P=0.413), respectively. Older age, heart failure, and hemodynamic instability increased the risk of death (p<0.001). Conclusion: Hemoptysis, hemodynamic instability, diabetes mellitus, heart failure, and T wave inversions in precordial leads were the independent predictors of delayed diagnosis. Delayed PE diagnosis did not increase the patients' mortality rates.
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Aghajani et al. (2022) conducted a cohort in Pulmonary embolism (n=756). Delayed pulmonary embolism diagnosis vs. Timely diagnosis was evaluated on Overall survival (mortality) (HR 1.215, 95% CI 0.762-1.939, p=0.413). Delayed pulmonary embolism diagnosis did not significantly increase mortality risk compared to timely diagnosis (adjusted HR 1.215; 95% CI 0.762-1.939; P=0.413).
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