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Gellert GA, Kabat-Karabon A, Gellert GL, Rasławska-Socha J, Gorski S, Price T, Kuszczyński K, Marcjasz N, Palczewski M, Jaszczak J, Loh IK, Orzechowski PM. The potential of virtual triage AI to improve early detection, care acuity alignment, and emergent care referral of life-threatening conditions. Front Public Health 2024; 12:1362246. [PMID: 38807993 PMCID: PMC11131945 DOI: 10.3389/fpubh.2024.1362246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/27/2024] [Indexed: 05/30/2024] Open
Abstract
Objective To evaluate the extent to which patient-users reporting symptoms of five severe/acute conditions requiring emergency care to an AI-based virtual triage (VT) engine had no intention to get such care, and whose acuity perception was misaligned or decoupled from actual risk of life-threatening symptoms. Methods A dataset of 3,022,882 VT interviews conducted over 16 months was evaluated to quantify and describe patient-users reporting symptoms of five potentially life-threatening conditions whose pre-triage healthcare intention was other than seeking urgent care, including myocardial infarction, stroke, asthma exacerbation, pneumonia, and pulmonary embolism. Results Healthcare intent data was obtained for 12,101 VT patient-user interviews. Across all five conditions a weighted mean of 38.5% of individuals whose VT indicated a condition requiring emergency care had no pre-triage intent to consult a physician. Furthermore, 61.5% intending to possibly consult a physician had no intent to seek emergency medical care. After adjustment for 13% VT safety over-triage/referral to ED, a weighted mean of 33.5% of patient-users had no intent to seek professional care, and 53.5% had no intent to seek emergency care. Conclusion AI-based VT may offer a vehicle for early detection and care acuity alignment of severe evolving pathology by engaging patients who believe their symptoms are not serious, and for accelerating care referral and delivery for life-threatening conditions where patient misunderstanding of risk, or indecision, causes care delay. A next step will be clinical confirmation that when decoupling of patient care intent from emergent care need occurs, VT can influence patient behavior to accelerate care engagement and/or emergency care dispatch and treatment to improve clinical outcomes.
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Affiliation(s)
| | | | | | | | - Stanislaw Gorski
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Tim Price
- Infermedica Inc, London, United Kingdom
| | | | | | - Mateusz Palczewski
- Infermedica, Inc, Wroclaw, Poland
- Pediatric Surgery and Urology Department, Wroclaw Medical University, Wroclaw, Poland
| | | | - Irving K. Loh
- Infermedica, Inc, Wroclaw, Poland
- Ventura Heart Institute, California, Thousand Oaks, CA, United States
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Maughan BC, Jarman AF, Redmond A, Geersing GJ, Kline JA. Pulmonary embolism. BMJ 2024; 384:e071662. [PMID: 38331462 DOI: 10.1136/bmj-2022-071662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- Brandon C Maughan
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Angela F Jarman
- Department of Emergency Medicine, University of California Davis, Sacramento, CA
| | | | - Geert-Jan Geersing
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jeffrey A Kline
- Department of Emergency Medicine, Wayne State School of Medicine, Detroit, MI
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3
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van Maanen R, Trinks-Roerdink EM, Rutten FH, Geersing GJ. A systematic review and meta-analysis of diagnostic delay in pulmonary embolism. Eur J Gen Pract 2022; 28:165-172. [PMID: 35730378 PMCID: PMC9246192 DOI: 10.1080/13814788.2022.2086232] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Diagnostic delay in patients with pulmonary embolism (PE) is typical, yet the proportion of patients with PE that experienced delay and for how many days is less well described, nor are determinants for such delay. Objectives This study aimed to assess the prevalence and extent of delay in diagnosing PE. Methods A systematic literature search was performed to identify articles reporting delays in diagnosing PE. The primary outcome was mean delay (in days) or a percentage of patients with diagnostic delay (defined as PE diagnosis more than seven days after symptom onset). The secondary outcome was determinants of delay. Random-effect meta-analyses were applied to calculate a pooled estimate for mean delay and to explore heterogeneity in subgroups. Results The literature search yielded 10,933 studies, of which 24 were included in the final analysis. The pooled estimate of the mean diagnostic delay based on 12 studies was 6.3 days (95% prediction interval 2.5 to 15.8). The percentage of patients having more than seven days of delay varied between 18% and 38%. All studies assessing the determinants of coughing (n = 3), chronic lung disease (n = 6) and heart failure (n = 8) found a positive association with diagnostic delay. Similarly, all studies assessing recent surgery (n = 7) and hypotension (n = 6), as well as most studies assessing chest pain (n = 8), found a negative association with diagnostic delay of PE. Conclusion Patients may have symptoms for almost one week before PE is diagnosed and in about a quarter of patients, the diagnostic delay is even longer.
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Affiliation(s)
- R van Maanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - E M Trinks-Roerdink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - F H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - G J Geersing
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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4
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Delayed Diagnosis of Pulmonary Embolism. Am J Med 2022; 135:e63-e64. [PMID: 34936888 DOI: 10.1016/j.amjmed.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022]
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Zhou X, Wu Q, Hao T, Xu R, Hu X, Dong L. Expression and diagnostic value of circulating miRNA-190 and miRNA-197 in patients with pulmonary thromboembolism. J Clin Lab Anal 2020; 35:e23574. [PMID: 32920929 PMCID: PMC7843280 DOI: 10.1002/jcla.23574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/11/2020] [Accepted: 08/22/2020] [Indexed: 02/06/2023] Open
Abstract
Background Diagnosing pulmonary thromboembolism (PTE) remains challenging due to the lack of specific clinical symptoms and biomarkers. Circulating microRNAs (miRNAs) have proved to be potential biomarkers for numerous cardiovascular diseases. The aims of this study were to quantitatively analyze the expression of plasma miRNA‐190 and miRNA‐197 in patients with PTE and to evaluate the diagnostic value for PTE. Methods Thirty patients diagnosed with PTE by computed tomographic pulmonary angiography at the emergency department were enrolled in this study, and plasma was collected immediately. For comparison, myocardial infarction (MI, n = 45) and healthy participants (NC, n = 45) were recruited as the control groups. Quantitative reverse transcription PCR (qRT‐PCR) was conducted to reveal the relative expression levels of miRNA‐190 and miRNA‐197 in each group. The plasma concentrations of D‐dimer were measured by immunoturbidimetric assay. The diagnostic value was evaluated by analyzing the area under the receiver operating characteristic curve (AUC). Results The relative expression levels of miRNA‐190 and miRNA‐197 in the PTE group were both significantly higher than in the MI group (t = 3.602 t = 4.791, P < .05, respectively) and the healthy control group (t = 5.814, t = 5.886, P < .05, respectively). As diagnostic indicator, the sensitivity and specificity of miRNA‐190 were 75.56% and 80%, respectively, with an AUC of 0.7844 (95%CI: 0.6858‐0.8831, P < .001). The sensitivity and specificity of miRNA‐197 were 73.33% and 86.67%, respectively, with an AUC value of 0.7931 (95%CI: 0.6870‐0.8991, P < .001). Combining miRNA‐190 and miRNA‐197 with D‐dimer levels significantly increased the diagnostic power, improving the AUC to 0.9536 (95% CI: 0.9083‐0.9989, P < .001). Conclusions The relative expression levels of miRNA‐190 and miRNA‐197 in PTE patients were significantly higher than in the MI and healthy control groups, indicating that (a) both may be involved in the pathophysiological process of PTE and (b) both may serve as potential noninvasive diagnostic markers for PTE. The combination of miRNA‐190, miRNA‐197, and D‐dimer levels showed better sensitivity and specificity, which is more conducive to the diagnosis of PTE.
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Affiliation(s)
- XiaoTing Zhou
- Department of Respiratory and Critical Care Medicine, Suzhou Ninth People's Hospital (The Affiliated Wujiang Hospital of Nantong University), Soochow, China
| | - QiaoZhen Wu
- Department of Respiratory and Critical Care Medicine, Suzhou Ninth People's Hospital (The Affiliated Wujiang Hospital of Nantong University), Soochow, China
| | - TianBo Hao
- Department of clinical laboratory, Suzhou Ninth People's Hospital (The Affiliated Wujiang Hospital of Nantong University), Soochow, China
| | - Rui Xu
- Department of Respiratory and Critical Care Medicine, Suzhou Ninth People's Hospital (The Affiliated Wujiang Hospital of Nantong University), Soochow, China
| | - XiaoYun Hu
- Department of Respiratory and Critical Care Medicine, Suzhou Ninth People's Hospital (The Affiliated Wujiang Hospital of Nantong University), Soochow, China
| | - LingYun Dong
- Department of Respiratory and Critical Care Medicine, Suzhou Ninth People's Hospital (The Affiliated Wujiang Hospital of Nantong University), Soochow, China
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Goyard C, Côté B, Looten V, Roche A, Pastré J, Marey J, Planquette B, Meyer G, Sanchez O. Determinants and prognostic implication of diagnostic delay in patients with a first episode of pulmonary embolism. Thromb Res 2018; 171:190-198. [PMID: 30190113 DOI: 10.1016/j.thromres.2018.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/26/2018] [Accepted: 08/22/2018] [Indexed: 01/24/2023]
Abstract
Signs and symptoms of pulmonary embolism (PE) are not specific and this can lead to a diagnostic delay. Little is known about the determinants of this delay and its prognostic implication. We conducted a retrospective analysis of a prospective cohort involving 514 patients with a first episode of PE. The diagnostic delay was defined as a time from first symptom onset to diagnosis of >3 days, corresponding of the median time in the population. Multivariable logistic regression analysis was performed to identify determinants of diagnostic delay. Prognostic implication was measured as the occurrence of 30-day all-cause mortality, haemodynamic collapse or recurrent PE. A total of 240 (47%) among 514 patients had a time from first symptom to diagnosis > 3 days. Previous deep vein thrombosis (OR 0.55, 95% Confidence Interval (CI), 0.32-0.93), immobilization (OR 0.52, 95% CI, 0.28-0.96), surgery (OR 0.31, 95% CI, 0.16-0.62), chest pain (OR 0.58, 95% CI, 0.39-0.86), syncope (OR 0.48, 95% CI, 0.23-1.01), dyspnea (OR 2.48, 95% CI, 1.57-3.91) and hemoptysis (OR 3.57, 95% CI, 1.40-9.07) were associated with diagnostic delay. Twenty-two patients (4.3%, 95%CI, 2.8-6.5) experienced an outcome event within 30 days. Among them, 15 patients (6.2% 95%CI, 3.7-10.3) had a diagnostic delay and 7 (2.6%, 95% CI 1.1-5.4) did not (p = 0.039). In this cohort, diagnostic delay is associated with the absence of major risk factors for PE or clinical features such as chest pain or syncope and the presence of dyspnea or hemoptysis. Diagnostic delay is associated with a worse 30-day prognosis.
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Affiliation(s)
- Céline Goyard
- Université Paris Descartes, Sorbonne Paris Cité, France; Division of Respiratory and Intensive Care Medicine, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, France
| | - Benoit Côté
- Département de médecine interne, Hôpital de l'Enfant-Jésus du CHU de Québec, Université Laval, Québec, Canada.
| | - Vincent Looten
- Université Paris Descartes, Sorbonne Paris Cité, France; Division of Medical Informatics, Biostatistics and Public Health, Hôpital Européen Georges Pompidou, France; INSERM UMRS 1138, Paris, France
| | - Anne Roche
- Université Paris Descartes, Sorbonne Paris Cité, France; Division of Respiratory and Intensive Care Medicine, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, France
| | - Jean Pastré
- Université Paris Descartes, Sorbonne Paris Cité, France; Division of Respiratory and Intensive Care Medicine, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, France
| | - Jonathan Marey
- Université Paris Descartes, Sorbonne Paris Cité, France; Division of Respiratory and Intensive Care Medicine, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, France
| | - Benjamin Planquette
- Université Paris Descartes, Sorbonne Paris Cité, France; Division of Respiratory and Intensive Care Medicine, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, France; INSERM UMRS 1140, Paris, France; F-CRIN, INNOVTE, Saint-Etienne, France
| | - Guy Meyer
- Université Paris Descartes, Sorbonne Paris Cité, France; Division of Respiratory and Intensive Care Medicine, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, France; F-CRIN, INNOVTE, Saint-Etienne, France; INSERM UMRS_970 and CIC 1418, Paris, France
| | - Olivier Sanchez
- Université Paris Descartes, Sorbonne Paris Cité, France; Division of Respiratory and Intensive Care Medicine, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, France; INSERM UMRS 1140, Paris, France; F-CRIN, INNOVTE, Saint-Etienne, France.
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7
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Villablanca PA, Vlismas PP, Aleksandrovich T, Omondi A, Gupta T, Briceno DF, Garcia MJ, Wiley J. Case report and systematic review of pulmonary embolism mimicking ST-elevation myocardial infarction. Vascular 2018; 27:90-97. [DOI: 10.1177/1708538118791917] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background To study trends in the clinical presentation, electrocardiograms, and diagnostic imaging in patients with pulmonary embolism presenting as ST segment elevation. Methods We performed a systematic literature search for all reported cases of pulmonary embolism mimicking ST-elevation myocardial infarction. Pre-specified data such as clinical presentation, electrocardiogram changes, transthoracic echocardiographic findings, cardiac biomarkers, diagnostic imaging, therapy, and outcomes were collected. Results We identified a total of 34 case reports. There were 23 males. Mean age of the population was 56.5 ± 15.5 years. Patients presented with dyspnea (76.4%), chest pain (63.6%), and tachycardia (71.4%). All patients presented with ST-elevations, with the most common location being in the anterior-septal distribution, lead V3 (74%), V2 (71%), V1 (62%) and V4 (47%). ST-segment elevations in the inferior distribution were present in lead II (12%), III (18%), and aVF (21%). Presentation was least likely in the lateral distribution. Troponin was elevated in 78.9% of cases. Right ventricular strain was the most common echocardiographic finding. Over 80% of patients had findings consistent with elevated right ventricular pressure, with 50% reported RV dilatation and 20% RV hypokinesis. The most commonly used imaging modality was contrast-enhanced pulmonary angiography. There was a greater incidence of bilateral compared to unilateral pulmonary emboli (72.4% vs. 10%). About 65% patients received anticoagulation and 36.3% were treated with thrombolytics. Forty-six percent of patients required intensive care and 18.7% intubation. Overall mortality was 25.8%. Conclusions A review of the literature reveals that in patients presenting with pulmonary embolism, electrocardiogram findings of ST-segment elevations will occur predominantly in the anterior-septal distribution.
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Affiliation(s)
- Pedro A Villablanca
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Peter P Vlismas
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tatsiana Aleksandrovich
- Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Arthur Omondi
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tanush Gupta
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - David F Briceno
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mario J Garcia
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jose Wiley
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
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Hendriksen JMT, Koster-van Ree M, Morgenstern MJ, Oudega R, Schutgens REG, Moons KGM, Geersing GJ. Clinical characteristics associated with diagnostic delay of pulmonary embolism in primary care: a retrospective observational study. BMJ Open 2017; 7:e012789. [PMID: 28279993 PMCID: PMC5353317 DOI: 10.1136/bmjopen-2016-012789] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To evaluate the extent of delay in the diagnosis of pulmonary embolism (PE) in primary care, and to identify determinants that are associated with such diagnostic delay. DESIGN Retrospective observational study. SETTING 6 primary care practices across the Netherlands. PARTICIPANTS Data from patients with an objectively confirmed diagnosis of PE (International Classification of Primary Care (ICPC) code K93) up to June 2015 were extracted from the electronic medical records. For all these PE events, we reviewed all consultations with their general practitioner (GP) and scored any signs and symptoms that could be attributed to PE in the 3 months prior to the event. Also, we documented actual comorbidity and the diagnosis considered initially. PRIMARY AND SECONDARY OUTCOME MEASURES Delay was defined as a time gap of >7 days between the first potentially PE-related contact with the GP and the final PE diagnosis. Multivariable logistic regression analysis was performed to identify independent determinants for delay. RESULTS In total, 180 incident PE cases were identified, of whom 128 patients had 1 or more potential PE-related contact with their GP within the 3 months prior to the diagnosis. Based on our definition, in 33 of these patients (26%), diagnostic delay was observed. Older age (age >75 years; OR 5.1 (95% CI 1.8 to 14.1)) and the absence of chest symptoms (ie, chest pain or pain on inspiration; OR 5.4 (95% CI 1.9 to 15.2)) were independent determinants for diagnostic delay. A respiratory tract infection prior to the PE diagnosis was reported in 13% of cases without delay, and in 33% of patients with delay (p=0.008). CONCLUSIONS Diagnostic delay of more than 7 days in the diagnosis of PE is common in primary care, especially in the elderly, and if chest symptoms, like pain on inspiration, are absent.
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Affiliation(s)
- Janneke M T Hendriksen
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marleen Koster-van Ree
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcus J Morgenstern
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ruud Oudega
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roger E G Schutgens
- Department of Internal Medicine, University Medical Center Utrecht, Van Creveldkliniek, Utrecht, The Netherlands
| | - Karel G M Moons
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert-Jan Geersing
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Nishiguchi S, Inada H, Kitagawa I, Tokuda Y. Factors associated with a delayed diagnosis of pulmonary embolism. ACTA ACUST UNITED AC 2016. [PMID: 29536882 DOI: 10.1515/dx-2016-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute pulmonary embolism (PE) is frequently a fatal disease. The clinical presentation of PE is variable and frequently nonspecific, and there is commonly a diagnostic delay. We aimed to investigate factors associated with the delay in the diagnosis of PE. METHODS Data from patients with PE were collected from January 2011 to December 2013 in an acute care teaching hospital. Time-to-diagnosis, evaluated by obtaining a diagnostic computed tomography scan, was then analyzed by the Cox proportional hazard model for examining factors associated with time to the diagnosis of PE. Independent variables included age, gender, activities of daily living, means of transport to the hospital, body temperature, hypoxemia, typical symptoms for PE, serum C-reactive protein (CRP) concentrations, infiltration on chest radiograph, Wells score, classification of patients with PE based on early mortality risk, patients referred from other specialties, daytime versus nighttime arrival, diagnosed by an emergency physician, and diagnosed by a medical resident. RESULTS Sixty patients were included. The time to diagnosis was significantly delayed in low-risk patients (hazard ratio [HR], 2.2; 95% CI, 1.2-4.1) and in patients who did not use an ambulance (HR, 1.9; 95% CI, 1.0-3.7). In an analysis of the latter subgroup, higher serum CRP concentrations were associated with a delayed diagnosis (HR, 1.1; 95% CI, 1.0-1.2). CONCLUSION The time to the diagnosis of PE was delayed in low-risk patients and in patients who attended the hospital by means other than an ambulance. In such patients, a delayed diagnosis was associated with higher serum CRP concentrations.
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Affiliation(s)
- Sho Nishiguchi
- 1Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Haruka Inada
- 1Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Izumi Kitagawa
- 1Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
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Perfusion SPECT in patients with suspected pulmonary embolism: how much sensitivity is needed to keep patients alive? Eur J Nucl Med Mol Imaging 2013; 40:1428-31. [PMID: 23748237 DOI: 10.1007/s00259-013-2470-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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