Caspian Journal of Internal Medicine
1
Caspian J Intern Med
Medical Sciences
http://caspjim.com
1
admin
2008-6164
2008-6172
8
10.22088/cjim
14
8888
13
en
jalali
1401
6
1
gregorian
2022
9
1
13
4
online
1
fulltext
en
Predictors and mortality of patients with delayed pulmonary embolism diagnosis: A cohort study
Cardiology
Cardiology
Original Article
Original Article
<span style="font-size:14px;"><span style="font-family:Times New Roman;"><span style="line-height:14pt"><b><i><span style="color:blue">Background</span></i></b><i><span style="color:blue">:</span></i> Some earlier studies demonstrated an increased mortality risk attributed to delayed pulmonary embolism (PE) diagnosis. Therefore, we mainly aimed to determine the predictors of diagnostic delays and the effect of delayed diagnosis on mortality.<span style="font-size:9.0pt"></span></span><br>
<span style="line-height:14pt"><b><i><span style="color:blue">Methods:</span></i></b> We prospectively studied 756 consecutive patients admitted with PE between March 2007 and September 2017. The delayed diagnosis was defined as (1) patient presenting > 7 days after onset of symptoms, (2) diagnosis takes > 24 hours upon arriving in the ED, or (3) undergoing coronary angiography before establishing PE diagnosis.<span style="font-size:10.0pt"></span></span><br>
<span style="line-height:14pt"><b><i><span style="color:blue">Results:</span></i></b> A total of 127 (16.7%) patients met the delayed group’s criteria. Heart failure (OR= 2.257, 95% CI: 1.130-4.508, P= 0.021), diabetes mellitus (OR= 1.568, 95% CI: 0.996-2.469, P= 0.052), and precordial T wave inversions (OR=2.559, 95% CI: 1.649-3.970, P< 0.001) were linked to higher rates of delayed diagnosis, while hemoptysis (OR=0.254, 95% CI: 0.059-1.087, P= 0.065) and hemodynamic instability (OR= 0.434, 95% CI: 0.168-1.123, P= 0.085) negatively correlated with it. Delayed PE diagnosis did not significantly impact the overall survival during the follow-up. The unadjusted and adjusted mortality hazard ratio for delayed diagnosis were 1.198 (95% CI: 0.758- 1.894, P= 0.439) and 1.215 (95% CI: 0.762- 1.939, P=0.413), respectively.<b> </b>Older age, heart failure, and hemodynamic instability increased the risk of death (p<0.001).<b><i><span style="color:blue"></span></i></b></span><br>
<b><i><span style="color:blue">Conclusion</span></i></b><i><span style="color:blue">:</span></i> Hemoptysis, hemodynamic instability, diabetes mellitus, heart failure, and T wave inversions in precordial leads were the independent predictors of delayed diagnosis. Delayed PE diagnosis did not increase the patients' mortality rates.</span></span>
Delayed diagnosis, Mortality, Pulmonary embolism, Pulmonary thromboembolism
757
764
http://caspjim.com/browse.php?a_code=A-10-2518-1&slc_lang=en&sid=1
Hassan
Aghajani
aghajanihas@gmail.com
100319475328460039879
100319475328460039879
No
Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
Susan
Hashemi
Susan93h@gmail.com
100319475328460039880
100319475328460039880
No
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
Amirali
Karimi
karimi.amirali.1999@gmail.com
100319475328460039881
100319475328460039881
No
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Somayeh
Yadangi
yadangi@modares.ac.ir
100319475328460039882
100319475328460039882
No
Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
Arash
Jalali
arjalali@tums.ac.ir
100319475328460039883
100319475328460039883
No
Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
Yaser
Jenab
yasjenab@gmail.com
100319475328460039884
100319475328460039884
Yes
Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran