Impact of Delay in Clinical Presentation on the Diagnostic Management and Prognosis of Patients with Suspected Pulmonary Embolism

Paul L. den Exter*, Josien van Es, Petra M. G. Erkens, Mark J. G. van Roosmalen, Pim van den Hoven, Marcel M. C. Hovens, Pieter W. Kamphuisen, Frederikus A. Klok, Menno V. Huisman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Rationale: The nonspecific clinical presentation of pulmonary embolism (PE) frequently leads to delay in its diagnosis. Objectives: This study aimed to assess the impact of delay in presentation on the diagnostic management and clinical outcome of patients with suspected PE. Methods: In 4,044 consecutive patients with suspected PE, patients presenting more than 7 days from the onset of symptoms were contrasted with those presenting within 7 days as regards the safety of excluding PE on the basis of a clinical decision rule combined with D-dimer testing. Patients were followed for 3 months to assess the rates of recurrent venous thromboembolism and mortality. Measurements and Main Results: A delayed presentation (presentation >7 d) was present in 754 (18.6%) of the patients. The failure rate of an unlikely clinical probability and normal D-dimer test was 0.5% (95% confidence interval [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. Patients with PE with diagnostic delay more frequently had centrally located PE (41% vs. 26%; P
Original languageEnglish
Pages (from-to)1369-1373
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number12
Publication statusPublished - 15 Jun 2013


  • pulmonary embolism
  • diagnosis
  • diagnostic delay
  • duration of symptoms
  • prognosis

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