Delay and misdiagnosis in sub-massive and non-massive acute pulmonary embolism
Delay and misdiagnosis in sub-massive and non-massive acute pulmonary embolism
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DOI：
10.1016/j.ejim.2010.04.005
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发表时间：
2010-08-01
影响因子：
8
通讯作者：
Urbieta Echezarreta, M. A.
中科院分区：
文献类型：
--
作者：
Alonso-Martinez, J. L.;Anniccherico Sanchez, F. J.;Urbieta Echezarreta, M. A.
背景：关于急性肺栓塞诊断延迟的程度和临床重要性的信息有限。患者和方法：1998 年至 2009 年间，对单个科室登记处诊断为急性肺栓塞的所有连续患者进行了评估。我们将症状的开始或转变记录为肺栓塞的开始以及患者接受治疗的错误诊断。我们评估了与延误和误诊相关的因素及其与死亡率的关系。结果：总共对 375 名患者进行了评估。中位年龄为 75 岁，四分位数间距 (IQR) 15，女性 186 岁 (49%)。中位延迟为 6 (IQR 12) 天。 Wells 评分中位数为 4.5 (IQR 3)。50% (95% CI 44-55) 的患者诊断延迟超过 6 天，25% (95% CI 21-30) 的患者诊断延迟超过 14 天，10% (95% CI 7-13) 的患者诊断延迟超过 21 天。 50% (95% CI 44-55) 的患者发生误诊。年龄较大、延误天数较多以及无晕厥或突发性呼吸困难是误诊的相关因素。对 331 名患者进行了中位随访 31 (IQR 45) 个月。 36% (95% CI 33-43) 的患者死亡[中位时间 8 (IQR 29) 个月]。较高的年龄、误诊和癌症病史是与死亡率相关的因素。延误天数与死亡率无关。结论：肺栓塞的延误和误诊很常见。老年患者以及无晕厥或突发性呼吸困难的患者容易误诊。诊断延迟不影响死亡率。 (C) 2010 年欧洲内科联合会。由爱思唯尔 BM 出版。版权所有。
Background: There is limited information about the extent and clinical importance of the delay in the diagnosis of acute pulmonary embolism.Patients and methods: Between 1998 and 2009, all consecutive patients diagnosed of acute pulmonary embolism from a registry of a single department were evaluated. We recorded the start or shift in symptoms as the beginning of pulmonary embolism and the mistaken diagnosis for which the patients had been treated. We evaluated the factors associated with the delay and misdiagnosis and their relation with mortality.Results: Overall 375 patients were evaluated. Median age was 75 years, interquartile range (IQR) 15, and female 186 (49%). Median delay was 6 (IQR 12) days. Median Wells score was 4.5 (IQR 3).Delay in diagnosis was longer than 6 days in 50% (95% CI 44-55) of patients, longer than 14 days in 25% (95% CI 21-30) and longer than 21 days in 10% (95% CI 7-13). Misdiagnosis occurred in 50% (95% CI 44-55) of patients. Higher age, more days of delay and the absence of syncope or sudden onset dyspnea were factors associated with misdiagnosis.Follow-up was carried out in 331 patients during a median of 31 (IQR 45) months. 36% (95% CI 33-43) of patients died [median 8 (IQR 29) months]. Higher age, misdiagnosis and a history of cancer were factors associated with mortality. Days of delay were not associated with mortality.Conclusions: Delay and misdiagnosis of pulmonary embolism is frequent. Elderly patients and the absence of syncope or sudden onset dyspnea favour the misdiagnosis. Delay in diagnosis does not participate in mortality. (C) 2010 European Federation of Internal Medicine. Published by Elsevier BM. All rights reserved.