title: Delay in diagnosis of pulmonary thromboembolism in emergency department: is it still a problem?
abstract: OBJECTIVE
  Pulmonary embolism (PE) is a common and serious disease that can result in death unless emergent diagnosis is made and treatment is initiated. In this study, we aimed to identify whether there is still a delay in the diagnosis of PE and to identify the time to delay in diagnosis and factors leading to this delay.
  
  
  METHODS
  This is a prospective observational cohort study performed in an emergency department (ED) of a tertiary care university hospital between September 2008 and September 2010. The rate and cause of delay in diagnosis were analyzed among patients with PE. The "delay" was defined as diagnosing after first 24 hours of symptom onset.
  
  
  RESULTS
  Among the 53 patients who were diagnosed with PE, a delay in diagnosis was present in 49 (93%) of them. Total delay time was 6.8 ± 7.7 days. In 33 (62%) patients, there was a delay of 4.6 ± 6.5 days due to patient-related factors. Delay in diagnosis after admission to hospital was 2.2 ± 2.9 days in 40 (75%) patients. In multivariate regression analysis, being female and having chest pain and cough were identified as significant factors causing patient-related delay. Unilateral leg edema, recent operation, and previous venous thromboembolism (VTE) history were the significant factors causing PE diagnosis without a delay. On the other hand, systemic hypertension as comorbidity was the only factor leading to physician-related delay.
  
  
  CONCLUSIONS
  The delay in diagnosis of PE in EDs still remains as an important problem. While being female and having chest pain and cough are significantly and independently associated with patient delay in diagnosis, the unilateral leg edema, recent operation, and previous VTE history cause physicians to diagnose on time. On the other hand, having hypertension as comorbidity may lead to physician delay. In order to prevent the delay in diagnosis, hospital-associated factors must be elucidated totally and more interventions must be made to increase public and professional awareness of the disease.
authors.affiliation: Department of Pulmonary Diseases, Gazi University School of Medicine, Ankara, Turkey. mugeaydogdu@yahoo.com
authors.forename: Müge
authors.initials: M
authors.lastname: Aydogdu
authors.forename: Nurettin Özgür
authors.initials: NÖ
authors.lastname: Dogan
authors.forename: Nazlı Topbaşı
authors.initials: NT
authors.lastname: Sinanoğlu
authors.forename: İpek Kıvılcım
authors.initials: İK
authors.lastname: Oğuzülgen
authors.forename: Ahmet
authors.initials: A
authors.lastname: Demircan
authors.forename: Fikret
authors.initials: F
authors.lastname: Bildik
authors.forename: Numan
authors.initials: N
authors.lastname: Ekim
mesh_terms: D000368:Aged; D015331:Cohort Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors; D014421:Turkey / Q000453:epidemiology