PB0937 - The consequences of delayed diagnosis of pulmonary embolism

Background: Although pulmonary thromboembolism (PE) is usually considered as an acute illness, delayed presentations are fairly common with different consequences

Aims: This study aims to investigate delays to presentation/diagnosis of patients with PE with the study and description of the clinical-paraclinical presentations and the long-term consequences.

Methods: All cases of PE diagnosed in our hospital between January 2020 and December 2022 were reviewed for the symptom onset, the dates of presentation, diagnosis, clinical and radiological findings. We compared patients diagnosed with PE during ED workup (early diagnosis-ED) with patients diagnosed with PE thereafter (delayed diagnosis-DD).

Results: Of the 168 patients enrolled, 30.4% presented to hospital 1 week after the start of their symptoms. The onset of symptoms suggestive of PE was on average 10.5± 11.4 days’ (median 4 days) before hospitalization (1 to 45 days), and about 1/3 of the patients visited at least one medical institution (15% - 2-3 institutions) prior to hospitalization. The delay from presentation to diagnosis was 1.9 ± 1.4 days ( range 0–16). Median age of patients with ED was significantly lower as compared to DD(65 vs. 78.3 years). Main symptoms were dyspnea (70 patients [60%] in early, 22 patients [45%] in delayed diagnosis), chest pain (60 patients [50.1%] in early, 9 patients [18.2%] in delayed diagnosis), and nonspecific complaints (11 patients [9,1%] in early, 15 patients [29.9%] in DD). Patients with hypotension, respiratory rate >20 and atelectasis in CT presented earlier. However, no correlation was found between delays and the level of thromboembolic occlusion in PA. In-hospital mortality was 4.6% in ED and 33.8% in DD.

Conclusion(s): Pulmonary thromboembolism should be considered not only in an acute setting, but also in patients with prolonged respiratory symptoms, since there was a significant delay to presentation amongst our patients. Delayed diagnosis of PE carries a worse prognosis than early diagnosis. .