Misdiagnosis of pulmonary embolism and missed pulmonary embolism: A systematic review of the literature

Kwok, Chun Shing; Wong, Chun Wai; Lovatt, Saul; Myint, Phyo Kyaw; Loke, Yoon K.

doi:10.1016/j.hsr.2022.100022

Cited by 21 publications

(22 citation statements)

References 15 publications

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“…The other important consideration is the possibility of misdiagnosis of PE which has been reported in the literature. 19 If patients are identified to have a pleural effusion but remain unwell despite treatment it merits investigation for PE. This is particularly important if the pleural aspiration shows an exudate and other causes such as malignancy or infection have been excluded.…”

Section: Impact Of Pleural Effusion On Clinical Outcomes In Patients ...mentioning

confidence: 99%

Impact of Pleural Effusion on Clinical Outcomes in Patients with Pulmonary Embolism: Insights from the National Inpatient Sample

et al. 2023

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Background: The incidence of hospital admissions for pulmonary embolism (PE) and associated pleural effusion, and the impact of these effusions on outcomes on a national level is unknown. Methods: Data from the National Inpatient Sample between 2016 to 2019 was used to conduct a retrospective nationwide cohort study of hospital admissions for PE with and without pleural effusion. Multiple logistic regressions and linear regression analyses were used to determine the independent impact of effusions on in-hospital mortality, length of stay, and cost. Results: There were 937,744 hospital admissions with PE included in our analysis (median age 64 [interquartile range 50-76] years; 52.5% females). The in-hospital mortality rate overall was 3.7% which was 5.5% for patients with pleural effusion and 3.6% for patients without pleural effusion (p<0.001). The median length of stay was longer in the group with pleural effusion (6 [3-12] days vs 4 [2-6] days, p<0.001) and the median healthcare cost was higher among patients with pleural effusion (13,689 [7,279-30,915] vs 8,855 [5,472-16,531], p<0.001). The factors most associated with pleural effusion were atrial fibrillation (OR 1.89 95%CI 1.78-2.00, p<0.001) and arterial thrombosis (OR 1.48 95%CI 1.19-1.84, p<0.001). Pleural effusion was associated with increased odds of mortality in patients with PE (OR 1.30 95%CI 1.18-1.45, p<0.001). Pleural effusion was associated with increased length of stay (Coefficient 4.15 95%CI 3.99 to 4.32, p<0.001), and healthcare costs (Coefficient 12,164; 95%CI:11,639 to 12,688, p<0.001)). Conclusion: Concomitant pleural effusion is not uncommon among PE patients which is more common in patients with atrial fibrillation and previous arterial thrombosis. Pleural effusions in patients with PE are associated with higher in-hospital mortality, length of stay and cost.

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Section: Impact Of Pleural Effusion On Clinical Outcomes In Patients ...mentioning

confidence: 99%

Impact of Pleural Effusion on Clinical Outcomes in Patients with Pulmonary Embolism: Insights from the National Inpatient Sample

et al. 2023

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“…For example, misdiagnosis has been identified to be frequent in conditions such as acute myocardial infarction [ 6 ], heart failure [ 7 ], aortic dissection [ 8 ], and pulmonary embolism [ 9 ]. Moreover, there may be limited resources or services in the area where the patient lives as there may be discrepancy in ease of access to healthcare depending on whether the area is urban or rural.…”

Section: Patient Pathwaysmentioning

confidence: 99%

Should Audits Consider the Care Pathway Model? A New Approach to Benchmarking Real-World Activities

et al. 2022

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Clinical audit is a method to assess the quality of healthcare services based on whether standards are met or not met. This approach is limited because it fails to recognize how decisions that take place over time and the natural progression of disease has an impact on what happens to patients and the care they receive. The aim of this paper is to introduce the concept of care pathway and explain how care pathways can be audited to better understand care. The care pathway is defined by clinically relevant events that take place within one or more healthcare institutions. The process begins with defining an ideal care pathway which is created by considering local expertise and guidelines. It is then possible to audit against the extent to which this ideal care pathway is achieved. This care pathway audit can enable identification of patterns in real-world care which can help with the of design interventions to help shift patients from the less to more desirable pathways. We conclude that through the process of the care pathway audit cycle, it is possible to learn about real-world activities, better utilize resources, promote safer care, improve quality of care, and help develop more effective interventions.

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“…In a systematic review by Kwok Chun S and associates (analysis of 18 studies), it was shown that the most common diagnoses with which PE is mixed are pneumonia, bronchitis, exacerbation of chronic obstructive pulmonary disease, heart failure and acute coronary syndrome [29]. Out of all the misdiagnosed conditions, the proportion with a wrong diagnosis of pneumonia, bronchitis or exacerbation of COPD represented 37.4%, while those wrongly diagnosed with heart failure and coronary artery disease or acute coronary syndrome were 18.2% and 12.4%, respectively [29].…”

Section: Diagnostic Doubts and Missed Diagnoses Of Vtementioning

confidence: 99%

“…The outcome of patients with PE largely depends not only on the correct diagnosis, but also on the delay in its diagnosis. Approximately 10% of patients with PE have a delay longer than 21 days in establishing the correct diagnosis [29,30]. The importance of prompt diagnosis and initiation of anticoagulant therapy is reflected in the high risk of early mortality in untreated PE [31].…”

Section: Diagnostic Doubts and Missed Diagnoses Of Vtementioning

confidence: 99%

Dilemmas in the Choice of Adequate Therapeutic Treatment in Patients with Acute Pulmonary Embolism - from Modern Recommendations to Clinical Application

Lasica¹,

Ašanin²,

Djukanovic³

et al. 2022

Preprint

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Pulmonary thromboembolism is a very common cardiovascular disease, with a still high mortality rate. Despite the clear guidelines, this disease still represents a great challenge both in diagnosis and treatment. Heterogeneous clinical picture, often without pathognomonic signs and symptoms, represents a huge differential diagnostic problem even for experienced doctors. The decision on the therapeutic regimen also represents a major dilemma in the group of patients who are hemodynamically stable at initial presentation and have signs of right ventricular (RV) dysfunction proven by echocardiography and positive biomarker values (pulmonary embolism of intermediate-high risk). Studies have shown conflicting results about the benefit of using fibrinolytic therapy in this group of patients until hemodynamic decompensation, due to the risk of major bleeding. The latest recommendations give preference to new oral anticoagulants (NOACs) compared to vitamin K antagonists (VKA), except for certain categories of patients (patients with antiphospholipid syndrome, mechanical valves, pregnancy). When using oral anticoagulant therapy, special attention should be paid to drug-drug interactions, which can lead to many complications, even to the death of the patient. Special population groups such as pregnant women, obese patients, patients with antiphospholipid syndrome and cancer represent a great therapeutic challenge in the application of anticoagulant therapy. In these patients, not only the effectiveness of the drugs must be taken into account, but great attention must be paid to their safety and possible side effects, which is why a multidisciplinary approach is emphasized in order to provide the best therapeutic option.

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Misdiagnosis of pulmonary embolism and missed pulmonary embolism: A systematic review of the literature

Cited by 21 publications

References 15 publications

Impact of Pleural Effusion on Clinical Outcomes in Patients with Pulmonary Embolism: Insights from the National Inpatient Sample

Impact of Pleural Effusion on Clinical Outcomes in Patients with Pulmonary Embolism: Insights from the National Inpatient Sample

Should Audits Consider the Care Pathway Model? A New Approach to Benchmarking Real-World Activities

Dilemmas in the Choice of Adequate Therapeutic Treatment in Patients with Acute Pulmonary Embolism - from Modern Recommendations to Clinical Application

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