Time delay between onset of symptoms and diagnosis in pulmonary thromboembolism

Although pulmonary thromboembolism is usually considered as an acute illness, delayed presentations are fairly common.

The purpose of this study was to investigate delays to presentation/diagnosis and their likely correlation with patients' clinical and radiographic findings in pulmonary thromboembolism.

All cases of pulmonary embolism diagnosed in our hospital between March 2002 and May 2006 were reviewed for the date of symptom onset, the dates of presentation and diagnosis, clinical findings, localization of embolism in pulmonary vascular tree and pleuropulmonary changes arising secondary to thrombotic occlusion. The parameters related to presentation delays were analyzed using a Mann-Whitney U test and logistic regression analysis.

Of the 178 patients enrolled, 30.4% presented to hospital 1 week after the start of their symptoms and there was an average of 8.4 +/- 11.4 days' (median 4 days, range 0-75) delay to presentation. The delay from presentation to diagnosis was 0.9 +/- 1.9 days (median 0, range 0-16). Patients with hypotension, respiratory rate >20 and atelectasis in spiral CT presented earlier. However, no correlation was found between delays and the level of thromboembolic occlusion in pulmonary artery.

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. The presence of hypotension and a high respiratory frequency was clearly associated with early presentation.