Factors associated with the timing of diagnosis of venous thromboembolism: results from the MASTER registry.
BACKGROUND
Signs and symptoms of venous thromboembolism (VTE) are non-specific and thus can make diagnosis difficult, even for an experienced clinician. We aimed to evaluate the timing of diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) in Italian hospitals and to identify individual and clinical predictors of timely or delayed diagnosis.


METHODS
MASTER is a multicenter prospective registry of patients with acute DVT and PE. Information on clinical presentation and diagnostic methods, temporary and permanent risk factors, were captured by an electronic data network at the time of the index event.


RESULTS
Data on 2047 patients (1024 males), 1505 with DVT and 542 with PE, were analysed. Delayed diagnosis (i.e. more than 10 days from onset of symptoms) was observed in 340 (22.6%) patients with DVT and in 88 (16.2%) with PE, respectively. In DVT patients, factors associated with earlier diagnosis were the presence of multiple signs or symptoms (p=0.014), the presence of pain (p=0.049), and previous venous thrombosis (p=0.016). Neither the presence of other known risk factors nor ongoing prophylaxis influenced the timing of diagnosis. In PE patients, only multiple signs or symptoms at presentation (p=0.014) and the presence of transient risk factors (p=0.001) were significantly associated with earlier diagnosis.


CONCLUSIONS
Substantial delays occur when diagnosing both DVT and PE. The severity of presentation, but not patient risk profile are associated with earlier diagnosis, even in patients with signs or symptoms of PE.
Ageno
Walter
W
U.O. Medicina I, Ospedale di Circolo, University of Insubria, Varese, Italy. agewal@yahoo.com
Agnelli
Giancarlo
G
Imberti
Davide
D
Moia
Marco
M
Palareti
Gualtiero
G
Pistelli
Riccardo
R
Rossi
Romina
R
Verso
Melina
M
D000293:Adolescent; D000328:Adult; D001330:Electronic Data Processing; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000453:epidemiology; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology