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Clinical characteristics associated with diagnostic delay of pulmonary embolism in primary care: a retrospective observational study

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: Dat...

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Autores principales: Hendriksen, Janneke M T, Koster-van Ree, Marleen, Morgenstern, Marcus J, Oudega, Ruud, Schutgens, Roger E G, Moons, Karel G M, Geersing, Geert-Jan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353317/
https://www.ncbi.nlm.nih.gov/pubmed/28279993
http://dx.doi.org/10.1136/bmjopen-2016-012789
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author Hendriksen, Janneke M T
Koster-van Ree, Marleen
Morgenstern, Marcus J
Oudega, Ruud
Schutgens, Roger E G
Moons, Karel G M
Geersing, Geert-Jan
author_facet Hendriksen, Janneke M T
Koster-van Ree, Marleen
Morgenstern, Marcus J
Oudega, Ruud
Schutgens, Roger E G
Moons, Karel G M
Geersing, Geert-Jan
author_sort Hendriksen, Janneke M T
collection PubMed
description 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.
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spelling pubmed-53533172017-03-17 Clinical characteristics associated with diagnostic delay of pulmonary embolism in primary care: a retrospective observational study Hendriksen, Janneke M T Koster-van Ree, Marleen Morgenstern, Marcus J Oudega, Ruud Schutgens, Roger E G Moons, Karel G M Geersing, Geert-Jan BMJ Open General practice / Family practice 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. BMJ Publishing Group 2017-03-09 /pmc/articles/PMC5353317/ /pubmed/28279993 http://dx.doi.org/10.1136/bmjopen-2016-012789 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle General practice / Family practice
Hendriksen, Janneke M T
Koster-van Ree, Marleen
Morgenstern, Marcus J
Oudega, Ruud
Schutgens, Roger E G
Moons, Karel G M
Geersing, Geert-Jan
Clinical characteristics associated with diagnostic delay of pulmonary embolism in primary care: a retrospective observational study
title Clinical characteristics associated with diagnostic delay of pulmonary embolism in primary care: a retrospective observational study
title_full Clinical characteristics associated with diagnostic delay of pulmonary embolism in primary care: a retrospective observational study
title_fullStr Clinical characteristics associated with diagnostic delay of pulmonary embolism in primary care: a retrospective observational study
title_full_unstemmed Clinical characteristics associated with diagnostic delay of pulmonary embolism in primary care: a retrospective observational study
title_short Clinical characteristics associated with diagnostic delay of pulmonary embolism in primary care: a retrospective observational study
title_sort clinical characteristics associated with diagnostic delay of pulmonary embolism in primary care: a retrospective observational study
topic General practice / Family practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353317/
https://www.ncbi.nlm.nih.gov/pubmed/28279993
http://dx.doi.org/10.1136/bmjopen-2016-012789
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