Impact of delay in clinical presentation on the diagnostic management and prognosis of patients with suspected pulmonary embolism

P. L. Den Exter, J. Van Es, P. G. M. Erkens, M. Roosmalen, P. Hoven, M. Hovens, P. W. Kamphuisen, F. A. Klok, M. Huisman

Research output: Contribution to journalMeeting AbstractAcademic


Background: The non-specific clinical presentation of pulmonary embolism (PE) frequently leads to delay in its diagnosis. Aims: To assess the impact of delay in presentation on the diagnostic management and clinical outcome of patients with suspected PE. Methods: For this post-hoc analysis, we used the combined data of two large multi-center, prospective studies that investigated the diagnostic management of patients with suspected PE. Patients presenting > 7 days from the onset of symptoms were contrasted to those presenting within 7 days as regards the safety of excluding PE on the basis of a clinical decision rule (CDR) combined with D-dimer testing. Patients were followed for 3 months to assess the rates of recurrent venous thromboembolism (VTE) and mortality. Results: Diagnostic delay (presentation > 7 days) was present in 754 (18.6%) of the total of 4044 patients. The failure rate of an unlikely clinical probability and normal D-dimer test was 0.5% (95% CI: 0.01- 2.7) for patients with and 0.5% (95% CI: 0.2-1.2) for those without diagnostic delay. D-dimer testing yielded a sensitivity of 99% (95%CI: 96-99%) and 98% (95%CI: 97-99%) in these groups respectively. PE patients with diagnostic delay more frequently had centrally located PE (41% vs. 26%, P > 0.001). The cumulative rates of recurrent VTE (4.6% vs. 2.7%, P = 0.14) and mortality (7.6% vs. 6.6%, P = 0.31) were not different for patients with and without diagnostic delay. Conclusions: PE can be safely excluded based on a CDR and D-dimer testing in patients with a delayed clinical presentation. Diagnostic delay for patients who survived acute PE was associated with a more central PE location although this did not affect the clinical outcome at 3 months.
Original languageEnglish
Pages (from-to)243
Number of pages1
JournalJournal of Thrombosis and Haemostasis
Publication statusPublished - Jul-2013


  • D dimer
  • prognosis
  • patient
  • human
  • lung embolism
  • society
  • thrombosis
  • hemostasis
  • diagnosis
  • mortality
  • venous thromboembolism
  • safety
  • prospective study
  • post hoc analysis


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