Timing of pulmonary embolism diagnosis in the emergency department

- Patients with pulmonary embolism benefit from rapid computed tomography diagnosis.
- Factor that significantly contribute to a time to diagnosis of less than 2 h in out-patients are tachycardia and a high embolus burden.
- Comorbidities, increased age and low embolus burden contribute to prolonged time to diagnosis at the emergency department.
- Patients admitted at day shift are significantly faster diagnosed.

BackgroundPatients with pulmonary embolism (PE) benefit from rapid diagnosis and treatment. The aim of the present study is to examine factors that contribute to the time between admission at the emergency department and diagnosis of PE (= time to diagnosis TTD).MethodsThis retrospective study included 241 patients with symptomatic PE that were admitted at the emergency department. Patient records were reviewed to obtain the relevant clinical information. Patients were assigned in one of three groups according to their TTD: short TTD ≤ 2 h; intermediate TTD > 2 h and ≤ 12 h; and prolonged TTD > 12 h. The groups were compared for differences in clinical factors. Furthermore multiple linear regression analyses based on TTD was performed.ResultsFactor that significantly contribute to a very short TTD < 2 h are tachycardia and a high embolus burden. Factors that significantly contribute to a diagnosis < 12 h are embolus burden, no COPD present, patient admitted at day shift, and a less pathologic ratio of ventricle axis. Multiple regression analyses identified increased age and low embolus burden as the strongest, independent factors for prolonged TTD.ConclusionsPatients with higher embolus load or signs of severe PE including tachycardia were most likely diagnosed within 2 h after presentation. More effort should be put in a faster diagnostic process in older patients and in patients with COPD.