Clinical features of patients inappropriately undiagnosed of pulmonary embolism

Am J Emerg Med. 2013 Dec;31(12):1646-50. doi: 10.1016/j.ajem.2013.08.037. Epub 2013 Sep 21.


Purposes: The objective of this study was to identify clinical factors associated with delayed diagnosis of acute pulmonary embolism (PE) in the emergency department (ED).

Basic procedures: A retrospective observational study was performed at three University affiliated Hospitals; 436 consecutive patients who presented to the ED with an acute PE confirmed by chest computed tomography from 2008 to 2011 were included. Patients were divided into 3 groups: group 1, PE was diagnosed while the patient was still in the ED; group 2, PE was diagnosed during hospitalization; group 3, patients who were sent home with a wrong alternative diagnosis and returned to the ED and were diagnosed of PE.

Main findings: One hundred forty-six patients (33.5%) had a delayed diagnosis of PE--21.5% belong to group 2 and 11.9% to Group 3. Chronic coexisting medical conditions like asthma or chronic obstructive pulmonary disease were independent predictors of a delayed diagnosis in patients who were admitted to hospital whereas non-specific and less severe symptoms like the presence of pleuro-mechanic thoracic pain, fever, hemoptysis, or the presence of a pulmonary infiltrate in chest x-ray were independent predictors of a delayed diagnosis in patients who were sent home.

Principal conclusions: Delay in diagnosis of acute PE is frequent despite current diagnostic strategies. Patients are sent home or admitted to hospital with a wrong diagnosis depending on clinical presentation or coexisting medical conditions.

Publication types

  • Observational Study

MeSH terms

  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Chest Pain / etiology
  • Comorbidity
  • Coronary Artery Disease / epidemiology
  • Cough / etiology
  • Delayed Diagnosis / statistics & numerical data*
  • Diabetes Mellitus / epidemiology
  • Diagnostic Errors / statistics & numerical data*
  • Emergency Service, Hospital
  • Female
  • Heart Failure / epidemiology
  • Hemoptysis / etiology
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Embolism / complications
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Smoking / epidemiology
  • Tomography, X-Ray Computed