初诊肺栓塞延迟诊断影响因素的分析

目的评估在初诊中肺栓塞（PE）诊断延迟的程度，确定诊断延迟相关的影响因素。方法回顾性分析2012年1月至2016年12月急诊科就诊的并最后确诊为肺栓塞患者，收集患者PE延迟诊断时间等临床资料。通过多因素logistic回归模型分析影响延迟诊断的因素。结果在总共1474例PE患者中，121例患者在1个月内PE相关症状而就诊，其中约24．0％存在诊断延迟。高龄和胸部症状缺失是诊断延迟的独立影响因素。而在非延迟诊断患者中伴随COPD和或哮喘率为14．1％，而在延迟诊断患者中占379％（P=0．013）。结论在初诊中，肺栓塞延迟诊断的情况仍较普遍，尤其是在老年人和胸部症状缺失的情况下。因此，初诊时需要时刻注意细节，更要在非典型患者中考虑肺栓塞诊断的可能。

Objective To assess the extent of delayed diagnosis of pulmonary embolism （ PE ） in primary care and to identify the factors associated with delayed diagnosis. Methods The clinical data of PE patients were collected and analyzed retrospectively from January 2012 to December 2016 at the emergency department, and time of diagnosis delay were documented. Multivariable logistic regression analysis was performed to identify independent determinants for delayed diagnosis. Results In total, 147 CTPA-confirmed PE cases were identified, of whom 121 patients had 1 or more potential PE-related contact with their doctor within the 1 month prior to the diagnosis. Based on our definition, in 29 of these patients （24.0 % ） , diagnostic delay was observed. Older age and the absence of chest symptoms were two independent determinants for the diagnostic delay. A history of COPD and/or asthma prior to the PE diagnosis was reported in 14.1% of cases without delay, and in 37.9% of patients with delay （ P=0.013 ） . Conclusion Diagnostic delay in the diagnosis of PE is common in primary care, especially in the elderly patients without chest symptoms. Therefore, we must pay attention to the details of patients＇ presentations at all times, and consider the possibility of pulmonary embolism in atypical patients.