Exploration of the causes of triage errors in initial diagnosis process for acute pulmonary embolism and acute aortic syndrome
Chen Qihong
Huang Jinqi
Chen Huang
Huang Zhongjie
Zhang Qingxian
Lin Jianxiong
Liu Aihua
Gao Xiaojie
Abstract：Objective To investigate the causes of triage errors in the initial diagnosis process for patients with acute pulmonary embolism(APE)and acute aortic syndrome(AAS).Methods A retrospective analysis was conducted on the clinical data of APE and AAS patients who were initially diagnosed in the Department of Cardiology at Putian First Hospital from July 2022 to February 2025.Their basic information,treatment plans,and in-hospital outcomes were recorded.Results A total of 35 patients were included,with 30 cases(85.7%)of APE and 5 cases(14.3%)of AAS.The latter included 2 cases of acute aortic dissection,2 cases of acute intramural aortic hematoma,and 1 case of aortic arch aneurysm with penetrating ulcer.The main symptoms were dyspnea in 19 cases(54.3%)and chest tightness in 17 cases(48.6%).The onset time ranged from 1 hour to half a year,with a median time of 2 days.There were 20 cases(57.1%)of patients seeking medical treatment during regular working hours,and 15 cases(42.9%)during noon breaks and nighttime.The time from admission to diagnosis ranged from 2 to 190 hours,with a median time of 30 hours.The positive rate of N-terminal pro-B-type natriuretic peptide was 61.3%(19/31),of high-sensitivity cardiac troponin I was 41.9%(13/31),and of D-dimer was 100%(35/35).The abnormality rate of electrocardiogram was 90.0%(27/30).Among the 30 APE patients,20 received anticoagulant therapy on the day of admission,while 10 did not.Two patients(5.7%)underwent emergency coronary angiography under digital subtraction angiography.Twenty-one patients(60.0%)received interventional treatment,including 4 cases(11.4%)of inferior vena cava filter placement,4 cases(11.4%)of pulmonary artery catheter-directed thrombolysis,11 cases(31.4%)of combined inferior vena cava filter placement and pulmonary artery catheter-directed thrombolysis,and 2 cases(5.7%)of thoracic aortic stent-graft placement.All patients had favorable in-hospital outcomes with no adverse events.Conclusion Objectively speaking,triage errors exist in the initial diagnosis process for APE and AAS in clinical practice.Optimizing the diagnostic and treatment process,with early chest contrast-enhanced CT scanning as a key measure,can help reduce triage errors in the initial diagnosis process.
Keywords：Acute pulmonary embolismAortic syndromeTriage errors in initial diagnosis processCause investigation
Publication Date：2025-04-20
Online Publishing Date：2025-11-20(First online date of this platform, not the publication date of the document)
Pages：4( 49-52 )