title: Prognostic significance of delays in diagnosis of pulmonary embolism.
abstract: OBJECTIVE
  To investigate the prognostic significance of a diagnostic delay of greater than 1 week after symptom onset in patients with pulmonary embolism (PE).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Emergency Department of Ramón y Cajal Hospital, a 1500-bed tertiary-care center in Madrid, Spain.
  
  
  METHODS
  Diagnosed with PE by objective testing between January 1, 2003, and June 30, 2005.
  
  
  METHODS
  All patients received standard anticoagulation therapy during follow-up.
  
  
  METHODS
  Death from any cause or symptomatic recurrent venous thromboembolism (VTE), confirmed by standard objective testing, within 3 months after PE diagnosis.
  
  
  RESULTS
  Of the 397 patients with acute PE, 72 (18%) had a diagnostic delay while 325 (82%) did not. The all-cause mortality rate was 13.1% at 3 months (95% CI=9.8-16.4%); due to 9 (12.5%) deaths in the diagnostic delay group and 43 (13.2%) deaths in the group without diagnostic delay (OR 0.9; 95% CI=0.4-2.0). Though multivariate analysis of clinical variables at the time of PE diagnosis identified active cancer, heart failure and immobility for more than 4 days as independent risk factors for death, diagnostic delay was not predictive. Recurrent VTE was observed in 3 (4.2%) of 72 patients with diagnostic delay and in 15 (4.6%) of 325 patients without diagnostic delay (odds ratio: 0.9; 95% CI=0.2-3.2). None of the variables analysed, including diagnostic delay, was associated with an increased risk of recurrent VTE during follow-up.
  
  
  CONCLUSIONS
  Among survivors diagnosed with acute PE in the Emergency Department, we did not detect an association between a delay in diagnosis and an increased risk of death or VTE recurrence during the ensuing 3 months of treatment.
authors.affiliation: Respiratory Division, Medicine Department, Ramón y Cajal Hospital, Alcalá de Henares University, 28034 Madrid, Spain. djc_69_98@yahoo.com
authors.forename: David
authors.initials: D
authors.lastname: Jiménez Castro
authors.forename: Antonio
authors.initials: A
authors.lastname: Sueiro
authors.forename: Gema
authors.initials: G
authors.lastname: Díaz
authors.forename: Carlos
authors.initials: C
authors.lastname: Escobar
authors.forename: Sergio
authors.initials: S
authors.lastname: García-Rull
authors.forename: Joaquín
authors.initials: J
authors.lastname: Picher
authors.forename: Dolores
authors.initials: D
authors.lastname: Taboada
authors.forename: Roger D
authors.initials: RD
authors.lastname: Yusen
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000401:mortality*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors