Effect of delay in hospital presentation on clinical and imaging findings in acute pulmonary thromboembolism.
BACKGROUND
There is limited information on the extent and clinical importance of the delay in hospital presentation of acute pulmonary thromboembolism (PTE).


OBJECTIVE
The aim of this study was to investigate the delay in hospital presentation of PTE and its association with clinical and imaging findings in PTE.


METHODS
This prospective study was conducted on patients admitted to our hospital with a diagnosis of acute PTE between September 2007 and September 2011. Relationships between delay in hospital presentation and clinical findings, risk factors, imaging findings, and in-hospital mortality were analyzed.


RESULTS
Of the 195 patients enrolled, 84 (43.1%) patients presented 3 days after the onset of symptoms. Patients with chest pain, history of immobility for more than 3 days, recent surgery, and estrogen use had significantly less delayed presentation. Right ventricular dysfunction was significantly more frequent in patients with delayed presentation (odds ratio [OR] = 2.38; 95% confidence interval [CI] 1.27-4.44; p = 0.006); however, no relationship was found between delay in presentation and pulmonary computed tomographic angiography or color Doppler sonography findings. Patients with delayed presentation were at higher risk of in-hospital mortality (OR = 4.32; 95% CI 1.12-16.49; p = 0.021).


CONCLUSIONS
Our study showed that a significant portion of patients with acute PTE had delayed presentation. Also, patients with delayed presentation had worse echocardiographic findings and higher in-hospital mortality.
Emergency Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Yaser
Y
Jenab
Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Mohammad Javad
MJ
Alemzadeh-Ansari
Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Seyedeh Arezoo
SA
Fehri
Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Neda
N
Ghaffari-Marandi
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Arash
A
Jalali
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000792:Angiography; D002637:Chest Pain / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D004452:Echocardiography; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012307:Risk Factors; D013575:Syncope / Q000209:etiology; D061665:Time-to-Treatment; D036542:Tomography, Spiral Computed; D018615:Ultrasonography, Doppler, Color; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging
delay in presentation; mortality; pulmonary thromboembolism; right ventricular dysfunction