Predictors and mortality of patients with delayed pulmonary embolism diagnosis: A cohort study
Background: 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. Methods: We prospectively studied 756 conse...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Babol University of Medical Sciences
2022-09-01
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| Series: | Caspian Journal of Internal Medicine |
| Subjects: | |
| Online Access: | http://caspjim.com/article-1-3179-en.html |
| _version_ | 1797984476818571264 |
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| author | Hassan Aghajani Susan Hashemi Amirali Karimi Somayeh Yadangi Arash Jalali Yaser Jenab |
| author_facet | Hassan Aghajani Susan Hashemi Amirali Karimi Somayeh Yadangi Arash Jalali Yaser Jenab |
| author_sort | Hassan Aghajani |
| collection | DOAJ |
| description | Background: 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.
Methods: 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.
Results: 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. Older age, heart failure, and hemodynamic instability increased the risk of death (p<0.001).
Conclusion: 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. |
| first_indexed | 2024-04-11T07:02:17Z |
| format | Article |
| id | doaj.art-4f7209d93a444c679419a84caf391605 |
| institution | Directory Open Access Journal |
| issn | 2008-6164 2008-6172 |
| language | English |
| last_indexed | 2024-04-11T07:02:17Z |
| publishDate | 2022-09-01 |
| publisher | Babol University of Medical Sciences |
| record_format | Article |
| series | Caspian Journal of Internal Medicine |
| spelling | doaj.art-4f7209d93a444c679419a84caf3916052022-12-22T04:38:35ZengBabol University of Medical SciencesCaspian Journal of Internal Medicine2008-61642008-61722022-09-01134757764Predictors and mortality of patients with delayed pulmonary embolism diagnosis: A cohort studyHassan Aghajani0Susan Hashemi1Amirali Karimi2Somayeh Yadangi3Arash Jalali4Yaser Jenab5 Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran Background: 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. Methods: 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. Results: 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. Older age, heart failure, and hemodynamic instability increased the risk of death (p<0.001). Conclusion: 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.http://caspjim.com/article-1-3179-en.htmldelayed diagnosismortalitypulmonary embolismpulmonary thromboembolism |
| spellingShingle | Hassan Aghajani Susan Hashemi Amirali Karimi Somayeh Yadangi Arash Jalali Yaser Jenab Predictors and mortality of patients with delayed pulmonary embolism diagnosis: A cohort study Caspian Journal of Internal Medicine delayed diagnosis mortality pulmonary embolism pulmonary thromboembolism |
| title | Predictors and mortality of patients with delayed pulmonary embolism diagnosis: A cohort study |
| title_full | Predictors and mortality of patients with delayed pulmonary embolism diagnosis: A cohort study |
| title_fullStr | Predictors and mortality of patients with delayed pulmonary embolism diagnosis: A cohort study |
| title_full_unstemmed | Predictors and mortality of patients with delayed pulmonary embolism diagnosis: A cohort study |
| title_short | Predictors and mortality of patients with delayed pulmonary embolism diagnosis: A cohort study |
| title_sort | predictors and mortality of patients with delayed pulmonary embolism diagnosis a cohort study |
| topic | delayed diagnosis mortality pulmonary embolism pulmonary thromboembolism |
| url | http://caspjim.com/article-1-3179-en.html |
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