Background: Prompt and early recognition of pulmonary embolism (PE) is paramount, given the associated mortality and morbidity if left untreated. However, this can be challenging due to non-specific signs and symptoms.

Aims: The purpose of this study was to gain insight into the prevalence of diagnostic delay and identify determinants that are associated with this delay. Therefore we systematically reviewed the literature and performed a meta-analysis on diagnostic delay in PE.

Methods: We performed a systematic literature search (Medline and Embase) to identify articles reporting on delay in diagnosing PE. Diagnostic delay was defined as the time between the onset of symptoms until confirmation of the PE diagnosis by diagnostic testing. The primary outcome of our study was diagnostic delay, which was expressed as either a mean delay or a percentage of patients with diagnostic delay. Secondary outcomes were determinants for such delay. Modified criteria based on the QUADAS-2 tool were used to assess the risk of bias. We performed random effect meta-analyses to calculate a pooled estimate for mean delay (including a 95% prediction interval) and to explore heterogeneity in subgroups.

Results: The literature search yielded a total of 8518 studies, of which 22 were included in our final analysis. The pooled estimate of the mean diagnostic delay was 6.3 days (95% PI 2.5 to 15.8 days). The percentage of patients having more than seven days of delay varied between 18% and 38%. Studies evaluating determinants associated with diagnostic delay show ambiguous and sometimes even conflicting results, with for no determinant having a clear association with or without delay.

Conclusions: Delay in diagnosing PE occurs frequently. Patients have experienced symptoms for nearly one week before diagnostic confirmation.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/a-systematic-review-and-meta-analysis-on-diagnostic-delay-in-pulmonary-embolism/