Effect of Delay in Hospital Presentation on Clinical and Imaging Findings in Acute Pulmonary Thromboembolism

Jenab, Yaser; Alemzadeh‐Ansari, Mohammad Javad; Fehri, Seyedeh Arezoo; Ghaffari-Marandi, Neda; Jalali, Arash

doi:10.1016/j.jemermed.2013.09.014

Cited by 8 publications

(5 citation statements)

References 18 publications

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“…Notably, the presence of pre-existent risk factors for VTE did not reduce the delay so much, while this association was reported in many other studies (17,18,22,23).…”

Section: Discussionmentioning

confidence: 57%

Diagnostic Delay of Pulmonary Embolism in COVID-19 Patients

et al. 2021

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Pulmonary embolism (PE) is a frequent, life-threatening COVID-19 complication, whose diagnosis can be challenging because of its non-specific symptoms. There are no studies assessing the impact of diagnostic delay on COVID-19 related PE. The aim of our exploratory study was to assess the diagnostic delay of PE in COVID-19 patients, and to identify potential associations between patient- or physician-related variables and the delay. This is a single-center observational retrospective study that included 29 consecutive COVID-19 patients admitted to the San Matteo Hospital Foundation between February and May 2020, with a diagnosis of PE, and a control population of 23 non-COVID-19 patients admitted at our hospital during the same time lapse in 2019. We calculated the patient-related delay (i.e., the time between the onset of the symptoms and the first medical examination), and the physician-related delay (i.e., the time between the first medical examination and the diagnosis of PE). The overall diagnostic delay significantly correlated with the physician-related delay (p < 0.0001), with the tendency to a worse outcome in long physician-related diagnostic delay (p = 0.04). The delay was related to the presence of fever, respiratory symptoms and high levels of lactate dehydrogenase. It is important to rule out PE as soon as possible, in order to start the right therapy, to improve patient's outcome and to shorten the hospitalization.

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“…Notably, the presence of pre-existent risk factors for VTE did not reduce the delay so much, while this association was reported in many other studies (17,18,22,23).…”

Section: Discussionmentioning

confidence: 57%

Diagnostic Delay of Pulmonary Embolism in COVID-19 Patients

et al. 2021

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“…Multiple other studies have concluded AADD to be associated with only a small decrease in sensitivity and likely safe in exclusion of PE 10–13 . Conversely, other reports have questioned whether this loss in sensitivity might lead to an unacceptable risk of missed PEs and potential harm, 30–33 although some PE diagnoses are of uncertain significance 34 . We evaluated patients who were discharged from the ED without a PE diagnosis and found that implementation of AADD did not lead to any change in the frequency of 30‐day mortality or missed PE.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] Conversely, other reports have questioned whether this loss in sensitivity might lead to an unacceptable risk of missed PEs and potential harm, [30][31][32][33] although some PE diagnoses are of uncertain significance. 34 We evaluated patients who were discharged from the ED without a PE diagnosis and found that implementation of AADD did not lead to any change in the frequency of 30-day mortality or missed PE. Overall, there were four patients with missed PE in the preimplementation period and two in the postimplementation period (Data Supplement S1, Appendix S4).…”

Section: Discussionmentioning

confidence: 99%

Effect of Using an Age‐adjusted D‐dimer to Assess for Pulmonary Embolism in Community Emergency Departments

Ghobadi

Lin

Musigdilok

et al. 2020

Academic Emergency Medicine

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Background The objective of this study was to evaluate the effect of changing the laboratory‐reported D‐dimer reference intervals to age‐adjusted reference intervals on the use of advanced chest imaging and 30‐day adverse events among emergency department (ED) encounters. Methods A retrospective interrupted time‐series analysis of ED encounters for patients > 50 years evaluated for suspected pulmonary embolism (PE) from April 2014 to April 2016. The primary outcome was use of advanced diagnostic imaging, and the secondary outcome was 30‐day mortality or PE diagnosis. Secondary analyses also quantified delayed PE diagnoses pre‐ and postintervention. A generalized estimating equation segmented logistic regression model, adjusting for patient and facility characteristics, was used to determine changes in odds of diagnostic imaging and 30‐day mortality or PE diagnoses. Results A total of 10,534 (5,153 pre‐ and 5,381 postimplementation) ED encounters were included. Advanced imaging was obtained in 35.9% of pre‐ versus 33% of postimplementation encounters. Age‐adjusted D‐dimer (AADD) showed a small and nonsignificant decrease in month‐to‐month trends of advanced chest imaging postimplementation (odds ratio [OR] = 0.98, 95% confidence interval [CI] = 0.96 to 1.00). Use of advanced imaging in patients with D‐dimer values lower than 500 ng/mL fibrinogen‐equivalent units (FEU) was similar in the preintervention (5.8%) and postintervention (6.8%) periods. However, imaging was obtained in 30% of patients postintervention with a D‐dimer result less than AADD reference interval , but more than the historical 500 ng/mL FEU reference interval. Implementing an AADD threshold demonstrated no change in the rate of 30‐day adverse events (missed PE or mortality). Conclusion Changing the laboratory‐reported D‐dimer reference intervals for evaluation of PE was not associated with reduction in advanced chest imaging and did not increase 30‐day adverse events. However, there was substantial noncompliance with the age‐adjusted reference intervals in the postintervention period likely blunting the impact of this intervention.

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“…Although two single centre Italian cohort studies concluded that gradual onset symptoms were present in only 3-6% of PE cases,2026 a larger multicentre cohort from 12 centres in the US found that 45% of patients with PE reported a gradual onset of symptoms 27. In contrast, patients with chest pain,101228 syncope,2329 or recent surgery29 appear less likely to experience delay or misdiagnosis of PE 30…”

Section: Why and How Often Is Pe Diagnosis Missed?mentioning

confidence: 99%

Pulmonary embolism

Maughan,

Jarman,

Redmond

et al. 2024

BMJ

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Effect of Delay in Hospital Presentation on Clinical and Imaging Findings in Acute Pulmonary Thromboembolism

Cited by 8 publications

References 18 publications

Diagnostic Delay of Pulmonary Embolism in COVID-19 Patients

Diagnostic Delay of Pulmonary Embolism in COVID-19 Patients

Effect of Using an Age‐adjusted D‐dimer to Assess for Pulmonary Embolism in Community Emergency Departments

Pulmonary embolism

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