A systematic review and meta-analysis of diagnostic delay in pulmonary embolism

Diagnostic delay in patients with pulmonary embolism (PE) is typical, yet the proportion of patients with PE that experienced delay and for how many days is less well described, nor are determinants for such delay. This study aimed to assess the prevalence and extent of delay in diagnosing PE. A systematic literature search was performed to identify articles reporting delays in diagnosing PE. The primary outcome was mean delay (in days) or a percentage of patients with diagnostic delay (defined as PE diagnosis more than seven days after symptom onset). The secondary outcome was determinants of delay. Random-effect meta-analyses were applied to calculate a pooled estimate for mean delay and to explore heterogeneity in subgroups. The literature search yielded 10,933 studies, of which 24 were included in the final analysis. The pooled estimate of the mean diagnostic delay based on 12 studies was 6.3 days (95% prediction interval 2.5 to 15.8). The percentage of patients having more than seven days of delay varied between 18% and 38%. All studies assessing the determinants of coughing (<i>n</i> = 3), chronic lung disease (<i>n</i> = 6) and heart failure (<i>n</i> = 8) found a positive association with diagnostic delay. Similarly, all studies assessing recent surgery (<i>n</i> = 7) and hypotension (<i>n</i> = 6), as well as most studies assessing chest pain (<i>n</i> = 8), found a negative association with diagnostic delay of PE. Patients may have symptoms for almost one week before PE is diagnosed and in about a quarter of patients, the diagnostic delay is even longer.

肺栓塞（pulmonary embolism, PE）患者的诊断延迟现象较为普遍，但针对发生诊断延迟的PE患者占比、延迟时长的具体数据，以及此类延迟的影响因素，目前仍鲜有详尽的研究与描述。本研究旨在评估PE诊断延迟的发生率与严重程度。研究通过系统文献检索，筛选报道PE诊断延迟相关数据的研究文献。本研究的主要结局指标为平均诊断延迟时长（以天为单位），或诊断延迟患者的占比（诊断延迟定义为症状发作后7天以上才确诊PE）；次要结局指标为诊断延迟的影响因素。研究采用随机效应模型荟萃分析，计算平均诊断延迟的合并效应量，并探索亚组间的异质性。本次文献检索共检索到10933项研究，最终纳入24项研究参与分析。基于12项研究的合并分析结果显示，平均诊断延迟时长为6.3天（95%预测区间为2.5~15.8天）。诊断延迟超过7天的患者占比在18%至38%之间波动。所有评估咳嗽（纳入研究数n=3）、慢性肺部疾病（n=6）与心力衰竭（n=8）作为影响因素的研究，均发现上述因素与PE诊断延迟呈正相关。同样，所有评估近期手术（n=7）与低血压（n=6）作为影响因素的研究，以及大部分评估胸痛（n=8）作为影响因素的研究，均发现上述因素与PE诊断延迟呈负相关。患者在确诊PE前，症状可能已持续近1周；而约四分之一的患者，其诊断延迟时长甚至更长。