Clinical characteristics associated with diagnostic delay of pulmonary embolism in primary care: a retrospective observational study
Open accessAbstract
Objectives: To evaluate the extent of delay in the diagnosis of pulmonary embolism (PE) in primary care, and to identify determinants that are associated with such diagnostic delay. Design: Retrospective observational study. Setting: 6 primary care practices across the Netherlands. Participants: Data from patients with an objectively confirmed diagnosis of PE (International Classification of Primary Care (ICPC) code K93) up to June 2015 were extracted from the electronic medical records. For all these PE events, we reviewed all consultations with their general practitioner (GP) and scored any signs and symptoms that could be attributed to PE in the 3 months prior to the event. Also, we documented actual comorbidity and the diagnosis considered initially. Primary and secondary outcome measures: Delay was defined as a time gap of >7 days between the first potentially PE-related contact with the GP and the final PE diagnosis. Multivariable logistic regression analysis was performed to identify independent determinants for delay. Results: In total, 180 incident PE cases were identified, of whom 128 patients had 1 or more potential PE-related contact with their GP within the 3 months prior to the diagnosis. Based on our definition, in 33 of these patients (26%), diagnostic delay was observed. Older age (age >75 years; OR 5.1 (95% CI 1.8 to 14.1)) and the absence of chest symptoms (ie, chest pain or pain on inspiration; OR 5.4 (95% CI 1.9 to 15.2)) were independent determinants for diagnostic delay. A respiratory tract infection prior to the PE diagnosis was reported in 13% of cases without delay, and in 33% of patients with delay (p=0.008). Conclusions: Diagnostic delay of more than 7 days in the diagnosis of PE is common in primary care, especially in the elderly, and if chest symptoms, like pain on inspiration, are absent.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
With such an immense cognitive burden placed on radiologists, delays in diagnosis and diagnostic errors are unavoidable.
“With such an immense cognitive burden placed on radiologists, delays in diagnosis and diagnostic errors are unavoidable6,7.”
From Self-supervised learning for medical image classification: a systematic review and implementation guidelines (2023) · cites this paper as [7]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Venous thromboembolism (VTE) in Europe
Agnelli, G., Anderson, F. A., Arcelus, J. I., Bergqvist, D., Brecht, J. G., Greer, I. A., Heit, J. A., Hutchinson, J., Kakkar, A. K., Mottier, D., et al. (2007) · Thrombosis and Haemostasis · doi:10.1160/th07-03-0212 · Cited by 1,573 · see citing works
Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors
Schiff, G. D. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.333 · Cited by 638 · see citing works
Risk of Fatal Pulmonary Embolism in Patients With Treated Venous Thromboembolism
Douketis, J. D. (1998) · JAMA · doi:10.1001/jama.279.6.458 · Cited by 612 · see citing works
Schouten, H. J., Geersing, G., Koek, H. L., Zuithoff, N. P. A., Janssen, K. J. M., Douma, R. A., van Delden, J. J. M., Moons, K. G. M., & Reitsma, J. B. (2013) · BMJ · doi:10.1136/bmj.f2492 · Cited by 341 · see citing works
Self-citationCoagulation and innate immune responses: can we view them separately?
Delvaeye, M., & Conway, E. M. (2009) · Blood · doi:10.1182/blood-2009-05-199208 · Cited by 315 · see citing works
Harper, P. L., Theakston, E., Ahmed, J., et al. (2007) · Internal Medicine Journal · doi:10.1111/j.1445-5994.2007.01388.x · Cited by 182 · see citing works
Geersing, G., Erkens, P. M. G., Lucassen, W. A. M., Buller, H. R., Cate, H. T., Hoes, A. W., Moons, K. G. M., Prins, M. H., Oudega, R., van Weert, H. C. P. M., et al. (2012) · BMJ · doi:10.1136/bmj.e6564 · Cited by 155 · see citing works
Self-citationInfections and inflammatory diseases as risk factors for venous thrombosis
Kluin‐Nelemans, H. C., Meijer, K., & Tichelaar, Y. I. G. V. (2012) · Thrombosis and Haemostasis · doi:10.1160/th11-09-0611 · Cited by 126 · see citing works
Kline, J. A., Hernandez‐Nino, J., Jones, A. E., Rose, G. A., Norton, H. J., & Camargo, C. A. (2007) · Academic Emergency Medicine · doi:10.1197/j.aem.2007.03.1356 · Cited by 102 · see citing works
Delay and misdiagnosis in sub-massive and non-massive acute pulmonary embolism
Alonso-Martínez, J. L., Sánchez, F. J. A., & Echezarreta, M. A. U. (2010) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2010.04.005 · Cited by 74 · see citing works
Ageno, W., Agnelli, G., Imberti, D., Moia, M., Palareti, G., Pistelli, R., Rossi, R., & Verso, M. (2007) · Thrombosis Research · doi:10.1016/j.thromres.2007.08.009 · Cited by 62 · see citing works
The role of risk factors in delayed diagnosis of pulmonary embolism
Özsu, S., Öztuna, F., Bülbül, Y., Topbaş, M., Özlü, T., Koşucu, P., & Ozsu, A. (2010) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2009.07.005 · Cited by 61 · see citing works
Clinical features of patients inappropriately undiagnosed of pulmonary embolism
Torres‐Macho, J., Mancebo-Plaza, A. B., Crespo-Giménez, A., de Barros, M. R. S., Bibiano-Guillén, C., Fallos-Martí, R., Calderón‐Parra, J., & de Miguel-Yanes, J. M. (2013) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2013.08.037 · Cited by 51 · see citing works
den Exter, P. L., van Es, J., Erkens, P. M. G., et al. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201212-2219oc · Cited by 51 · see citing works
Risk Factors Associated with Delayed Diagnosis of Acute Pulmonary Embolism
Smith, S. B., Geske, J. B., & Morgenthaler, T. I. (2011) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2011.06.004 · Cited by 39 · see citing works
Diagnostic delay of pulmonary embolism in primary and secondary care: a retrospective cohort study
Walen, S., Damoiseaux, R. A. M. J., Uil, S. M., et al. (2016) · British Journal of General Practice · doi:10.3399/bjgp16x685201 · Cited by 35 · see citing works
Meyer, G., Roy, P. M., Gilberg, S., et al. (2010) · BMJ · doi:10.1136/bmj.c1421 · Cited by 15 · see citing works
Delay in Diagnosis of Pulmonary Thromboembolism in Emergency Department
Aydoğdu, M., Doğan, N. Ö., Sinanoğlu, N. T., Oğuzülgen, İ. K., Demircan, A., Bildik, F., & Ekim, N. (2012) · Clinical and Applied Thrombosis/Hemostasis · doi:10.1177/1076029612440164 · Cited by 12 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [17]Timp J, Cannegieter S, Tichelaar V Risk of first and recurrent venous thrombosis in individuals treated with antibiotics. J Thromb Haemost 2015; 13: 983 10.1111/jth.12993 · DOI
Cited by
Sorted by citations
Huang, S.-C., Pareek, A., Jensen, M., Lungren, M. P., Yeung, S., & Chaudhari, A. S. (2023) · npj Digital Medicine · doi:10.1038/s41746-023-00811-0 · Cited by 479 · see citing works
“With such an immense cognitive burden placed on radiologists, delays in diagnosis and diagnostic errors are unavoidable 6,7 .”
BackgroundHuang, S.-C., Pareek, A., Zamanian, R., Banerjee, I., & Lungren, M. P. (2020) · Scientific Reports · doi:10.1038/s41598-020-78888-w · Cited by 246 · see citing works
- Authors
- Hendriksen, J. M. T., Koster-van Ree, M., Morgenstern, M. J., Oudega, R., Schutgens, R. E. G., Moons, K. G. M., & Geersing, G.-J.
- Affiliations
- University Medical Center Utrecht (NL)
- Corresponding author
- Hendriksen, Janneke M T
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2017-03
- Volume
- 7
- Issue
- 3
- Pages
- e012789
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5353317
- OpenAlex
- W2592969090
- Cited by
- 48
- References
- 18
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 6 · 2023: 9 · 2022: 7 · 2021: 5 · 2020: 3 · 2019: 2 · 2018: 3
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- pulmonary embolism, delayed diagnosis, primary care, general practitioners, chest pain, elderly patients, respiratory infections, clinical features
- MeSH terms
- Aged, Female, Humans, Male, Middle Aged, Netherlands, Pulmonary Embolism, Respiratory Tract Infections, Retrospective Studies, Venous Thromboembolism, Delayed Diagnosis, General Practice
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
