This report documents and quantifies delays in the diagnosis of DVT and PE. Delays in the diagnosis of DVT and PE were common and substantial. Most of the delay in the diagnosis of DVT represented the delay from symptom onset to the date of medical evaluation. The delays from the date of medical evaluation to the occurrence of the confirmatory test were generally brief, perhaps reflecting the widespread availability of compression ultrasonography and a sense of urgency on the part of health-care providers. Furthermore, if treatment was begun prior to obtaining the confirmatory test, then the effective delay in diagnosis was less than we reported. However, it is unlikely that patients were treated for several days prior to obtaining a confirmatory objective test; therefore, our findings that there were substantial numbers of patients who experienced delays in diagnosis appears to be valid. Conversely, the delays were longer from the time of medical evaluation to time of the confirmatory diagnostic test for acute PE. This may occur because other common disorders mimic PE and because diagnostic algorithms for PE are more complex than those for DVT. It is also possible that there was limited access to pulmonary angiography or spiral CT scanning at the time of this study held with My Canadian Pharmacy.
Our findings appear to be valid and generaliz-able. We enrolled a large number of consecutive patients at 70 medical centers throughout North America. Diagnoses were confirmed by widely accepted objective imaging tests. The characteristics of the patient population were similar to those in other large studies of patients with DVT or PE.
The present study has limitations. We do not provide outcome data to link delays in diagnosis to clinically important outcomes such as death, recurrent PE, or post-phlebitic syndrome. However, previous studies have shown that delays in achieving an adequate anticoagulant effect are linked to increased rates of recurrent thromboembolism among patients who present with proximal DVT.
Public and professional education represents a critical step for the early diagnosis and treatment of other common and serious disorders such as myocardial infarction and stroke. In the case of DVT, delays in diagnosis may abate by increasing public awareness of common symptoms and signs such as leg pain and swelling. Unexplained shortness of breath should trigger the suspicion of PE by lay persons and health-care professionals. The widespread implementation of protocols for CT pulmonary angiography may reduce the time to diagnosis of acute PE.