title: Clinical characteristics associated with diagnostic delay of pulmonary embolism in primary care: a retrospective observational study.
abstract: To evaluate the extent of delay in the diagnosis of pulmonary embolism (PE) in primary care, and to identify determinants that are associated with such diagnostic delay.
  
  
  
  Retrospective observational study.
  
  
  
  6 primary care practices across the Netherlands.
  
  
  
  Data from patients with an objectively confirmed diagnosis of PE (International Classification of Primary Care (ICPC) code K93) up to June 2015 were extracted from the electronic medical records. For all these PE events, we reviewed all consultations with their general practitioner (GP) and scored any signs and symptoms that could be attributed to PE in the 3 months prior to the event. Also, we documented actual comorbidity and the diagnosis considered initially.
  
  
  
  Delay was defined as a time gap of >7 days between the first potentially PE-related contact with the GP and the final PE diagnosis. Multivariable logistic regression analysis was performed to identify independent determinants for delay.
  
  
  
  In total, 180 incident PE cases were identified, of whom 128 patients had 1 or more potential PE-related contact with their GP within the 3 months prior to the diagnosis. Based on our definition, in 33 of these patients (26%), diagnostic delay was observed. Older age (age >75 years; OR 5.1 (95% CI 1.8 to 14.1)) and the absence of chest symptoms (ie, chest pain or pain on inspiration; OR 5.4 (95% CI 1.9 to 15.2)) were independent determinants for diagnostic delay. A respiratory tract infection prior to the PE diagnosis was reported in 13% of cases without delay, and in 33% of patients with delay (p=0.008).
  
  
  
  Diagnostic delay of more than 7 days in the diagnosis of PE is common in primary care, especially in the elderly, and if chest symptoms, like pain on inspiration, are absent.
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Janneke M T
authors.initials: JM
authors.lastname: Hendriksen
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Marleen
authors.initials: M
authors.lastname: Koster-van Ree
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Morgenstern
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Ruud
authors.initials: R
authors.lastname: Oudega
authors.affiliation: Department of Internal Medicine, University Medical Center Utrecht, Van Creveldkliniek, Utrecht, The Netherlands.
authors.forename: Roger E G
authors.initials: RE
authors.lastname: Schutgens
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Karel G M
authors.initials: KG
authors.lastname: Moons
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Geersing
mesh_terms: D000368:Aged; D057210:Delayed Diagnosis; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012141:Respiratory Tract Infections / Q000175:diagnosis; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000175:diagnosis
keywords: PRIMARY CARE; diagnostic delay; pulmonary embolism; venous thromboembolism