Chest

Chest

Volume 128, Issue 5, November 2005, Pages 3372-3376
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Clinical Investigations: VENOUS THROMBOEMBOLISM
Delays in Diagnosis of Deep Vein Thrombosis and Pulmonary Embolism

https://doi.org/10.1378/chest.128.5.3372Get rights and content

Purpose: To investigate delays in the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE).

Subjects and methods: We prospectively identified 1,152 patients in whom DVT or PE had been diagnosed at 70 North American medical centers. We recorded demographic characteristics and dates of symptom onset, initial medical evaluation, and confirmatory diagnostic tests.

Results: We identified substantial numbers of patients for whom there were delays in the diagnosis of DVT, PE, or both. For acute DVT, 170 of 808 patients (21%) received diagnoses > 1 week after symptom onset, and 40 of 808 patients (5%) received diagnoses > 3 weeks after symptom onset. On average, 80% of the delay in diagnosis of DVT occurred between symptom onset and medical evaluation. Acute PE was diagnosed in 59 of 344 patients (17%) > 1 week after symptom onset, and in 17 of 344 patients (5%) > 3 weeks after the onset of symptoms. Delays in the diagnosis of PE represented both delays in seeking medical attention (mean, 3 days; upper limit of 95% confidence interval [CI], 12 days); and delays from the first medical evaluation to diagnosis (mean, 2 days; upper limit of 95% CI, 9 days).

Conclusions: Although the majority of patients with DVT and PE seek medical attention and receive diagnoses promptly after symptom onset, substantial delays exist in the diagnosis of DVT and PE for many patients. There is a need to develop and test strategies that reduce delays in diagnosis.

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MATERIALS AND METHODS

Investigators at 70 medical centers (see “Appendix”) identified consecutive medical records with the hospital discharge diagnosis of DVT without symptoms of PE (“DVT”) or PE from August 1, 1999, through November 30, 1999. We included only patients who underwent a confirmatory objective imaging test (eg, compression ultrasonography) for DVT. Physicians and patients were not interviewed by the investigators. Data collection was approved by the local institutional review board.

Demographics (ie,

Patient Population and Diagnostic Tests

Study sites enrolled 1,160 patients with venous thromboembolism from August 1, 1999, through November 30, 1999. Eight patients were excluded from the study because the data were incomplete, leaving a study population of 1,152 patients. This population included 808 patients in whom isolated DVT had been diagnosed, and 344 patients in whom PE had been diagnosed. Two hundred fifty-one patients (31.1%) had deep vein thrombi limited to calf veins, and 557 patients (68.9%) had proximal deep vein

DISCUSSION

This report documents and quantifies delays in the diagnosis of DVT and PE. Delays in the diagnosis of DVT and PE were common and substantial. Most of the delay in the diagnosis of DVT represented the delay from symptom onset to the date of medical evaluation. The delays from the date of medical evaluation to the occurrence of the confirmatory test were generally brief, perhaps reflecting the widespread availability of compression ultrasonography and a sense of urgency on the part of

Participating Investigators and Study Sites

Kenneth Anderson, MD, Bluegrass Clinical Research, Louisville, KY; Jack E. Ansell, MD, Boston University Medical Center, Boston, MA; Amy Arouni, MD, Creighton Cardiac Center, Omaha, NE; Jeremy Brown, MD, Beth-Israel Deaconess Medical Center, Boston, MA; Frederick Brown, MD, Muskegon Surgical Group, Muskegon, MI; Paul Brownstone, MD, Alpine Clinical Research Center, Boulder, CO; Frank Burke, MD, Bluegrass Orthopaedics, Lexington, KY; Thomas Chippendale, MD, North County Neurology Associates,

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Copyright © 2005 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.