Risk factors associated with delayed diagnosis of acute pulmonary embolism

Sean B. Smith, Jeffrey B. Geske, Timothy I. Morgenthaler

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Background: Prompt diagnosis and treatment of acute pulmonary embolism (PE) is essential to reduce mortality. Risk factors for PE are well known, but factors associated with delayed diagnosis are less clear. Objective: Our objective was to identify clinical factors associated with delayed diagnosis of patients with acute PE presenting to a tertiary-care emergency department (ED). Methods: We studied 400 consecutive adults who presented to our ED with acute, symptomatic PE. All patients were diagnosed by computed tomography (CT) angiography. Early diagnosis was defined as CT diagnosis < 12 h from ED arrival, and delayed diagnosis as CT diagnosis > 12 h. Univariate and multiple logistic regression models were used to identify factors associated with delayed diagnosis. Odds ratios with 95% confidence intervals are reported. Results: The median time from arrival to diagnosis was 2.4 h (interquartile range 1.47.6), and 73 (18.3%) patients had delayed diagnosis. Patients aged > 65 years and those with coronary artery disease or congestive heart failure had longer times from ED arrival to CT diagnosis, whereas patients with recent immobility had shorter times. Patients diagnosed > 12 h were older and had higher rates of morbid obesity and coronary artery disease, whereas patients diagnosed < 12 h had higher rates of tachycardia. In multiple regression modeling, tachycardia and recent immobility remained associated with early diagnosis, whereas morbid obesity remained associated with delayed diagnosis. Conclusions: Older patients with cardiovascular comorbidities had longer times from ED arrival to CT diagnosis. Our data suggest that these patients represent more of a diagnostic challenge than those presenting with traditional risk factors for PE, such as tachycardia and recent immobilization. Physicians should consider these factors to diagnosis acute PE promptly in the ED.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalJournal of Emergency Medicine
Issue number1
StatePublished - Jan 2012


  • delay
  • diagnosis
  • pulmonary embolism
  • risk factors
  • timing

ASJC Scopus subject areas

  • Emergency Medicine


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