title: Risk factors associated with delayed diagnosis of acute pulmonary embolism.
abstract: BACKGROUND
  Prompt diagnosis and treatment of acute pulmonary embolism (PE) is essential to reduce mortality. Risk factors for PE are well known, but factors associated with delayed diagnosis are less clear.
  
  
  OBJECTIVE
  Our objective was to identify clinical factors associated with delayed diagnosis of patients with acute PE presenting to a tertiary-care emergency department (ED).
  
  
  METHODS
  We studied 400 consecutive adults who presented to our ED with acute, symptomatic PE. All patients were diagnosed by computed tomography (CT) angiography. Early diagnosis was defined as CT diagnosis<12h from ED arrival, and delayed diagnosis as CT diagnosis>12h. Univariate and multiple logistic regression models were used to identify factors associated with delayed diagnosis. Odds ratios with 95% confidence intervals are reported.
  
  
  RESULTS
  The median time from arrival to diagnosis was 2.4h (interquartile range 1.4-7.6), and 73 (18.3%) patients had delayed diagnosis. Patients aged>65 years and those with coronary artery disease or congestive heart failure had longer times from ED arrival to CT diagnosis, whereas patients with recent immobility had shorter times. Patients diagnosed>12h were older and had higher rates of morbid obesity and coronary artery disease, whereas patients diagnosed<12h had higher rates of tachycardia. In multiple regression modeling, tachycardia and recent immobility remained associated with early diagnosis, whereas morbid obesity remained associated with delayed diagnosis.
  
  
  CONCLUSIONS
  Older patients with cardiovascular comorbidities had longer times from ED arrival to CT diagnosis. Our data suggest that these patients represent more of a diagnostic challenge than those presenting with traditional risk factors for PE, such as tachycardia and recent immobilization. Physicians should consider these factors to diagnosis acute PE promptly in the ED.
authors.affiliation: Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55901, USA.
authors.forename: Sean B
authors.initials: SB
authors.lastname: Smith
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Geske
authors.forename: Timothy I
authors.initials: TI
authors.lastname: Morgenthaler
mesh_terms: D000208:Acute Disease; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis; D015897:Comorbidity; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed