Pulmonary embolism (PE) is a critical condition requiring prompt diagnosis and treatment, especially within primary care settings. Timely identification in primary care is crucial for effective patient management and improved outcomes. However, delays in diagnosis can occur, potentially leading to adverse consequences. Understanding the extent and determinants of these delays is essential for enhancing diagnostic accuracy and patient safety in primary care.
A recent study conducted across six primary care practices in the Netherlands investigated the prevalence and causes of diagnostic delay in pulmonary embolism. This retrospective observational study analyzed data from patients with confirmed PE diagnoses, reviewing their medical records for consultations with their general practitioners (GPs) in the three months preceding diagnosis. The research meticulously documented signs and symptoms potentially indicative of PE, existing comorbidities, and initial diagnoses considered by the GPs.
The study defined diagnostic delay as a period exceeding seven days between the first consultation with a GP for symptoms potentially related to PE and the final diagnosis of PE. Out of 180 identified PE cases, 128 patients had consulted their GP with possible PE-related symptoms in the three months prior to their diagnosis. Alarmingly, diagnostic delay was observed in 26% of these patients, highlighting a significant area for improvement in primary care settings.
Multivariable logistic regression analysis revealed key independent determinants associated with diagnostic delay. Older age, specifically patients over 75 years, was a significant factor, demonstrating a 5.1 times higher odds ratio for delayed diagnosis (95% CI 1.8 to 14.1). Furthermore, the absence of chest symptoms, such as chest pain or pain on inspiration, significantly increased the likelihood of delay, with an odds ratio of 5.4 (95% CI 1.9 to 15.2). This suggests that atypical presentations of PE, particularly in the elderly and those without classic chest pain, may contribute to diagnostic oversights.
Interestingly, the study also found a correlation between prior respiratory tract infections and diagnostic delay. While respiratory infections were reported in 13% of cases without delay, this figure rose to 33% in patients experiencing diagnostic delay (p=0.008). This suggests that symptoms of PE may be mistakenly attributed to respiratory infections, particularly in primary care where respiratory complaints are common, leading to a delayed recognition of the underlying pulmonary embolism.
In conclusion, this study underscores that diagnostic delay in pulmonary embolism is a common issue in primary care, especially among older patients and those presenting without chest pain. The findings emphasize the need for heightened clinical vigilance for PE in these at-risk groups. Considering PE as a differential diagnosis, even in the presence of symptoms suggestive of respiratory infection or in elderly patients without typical chest pain, is crucial for minimizing diagnostic delays and improving patient outcomes in primary care.
