Delays in diagnosis of deep vein thrombosis and pulmonary embolism

Purpose: To investigate delays in the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE). Subjects and methods: We prospectively identified 1,152 patients in whom DVT or PE had been diagnosed at 70 North American medical centers. We recorded demographic characteristics and dates of symptom onset, initial medical evaluation, and confirmatory diagnostic tests. Results: We identified substantial numbers of patients for whom there were delays in the diagnosis of DVT, PE, or both. For acute DVT, 170 of 808 patients (21%) received diagnoses > I week after symptom onset, and 40 of 808 patients (5%) received diagnoses > 3 weeks after symptom onset. On average, 80% of the delay in diagnosis of DVT occurred between symptom onset and medical evaluation. Acute PE was diagnosed in 59 of 344 patients (17%) > 1 week after symptom onset, and in 17 of 344 patients (5%) > 3 weeks after the onset of symptoms. Delays in the diagnosis of PE represented both delays in seeking medical attention (mean, 3 days; upper limit of 95% confidence interval [CI], 12 days); and delays from the first medical evaluation to diagnosis (mean, 2 days; upper limit of 95% CI, 9 days). Conclusions: Although the majority of patients with DVT and PE seek medical attention and receive diagnoses promptly after symptom onset, substantial delays exist in the diagnosis of DVT and PE for many patients. There is a need to develop and test strategies that reduce delays in diagnosis.