OBJECTIVETo evaluate the present status of pulmonary embolism (PE) misdiagnosis in China.

METHODSDocuments on PE misdiagnosis published in Chinese-language journals between 2001 and 2004 were identified by searching the China Hospital Knowledge Database in China National Knowledge Infrastructure Web (CNKI-CHKD). Retrospective review items include: patient symptoms, medical examination tools, treatments and prognosis, causes of death, hospitals involved. The recent situation on PE misdiagnosis was also compared to that in year between 1980 to 2000. The number of published literatures on PE and PE misdiagnosis from 1994 to 2004 was also searched.

RESULTS(1) A total of 110 documents with 1540 misdiagnosed PE patients were found. The misdiagnosis time varies from 0.5 hour to 16 years and was 1.86 years on average. (2) Once the misdiagnosis be corrected, the prognosis could be improved by antithrombotic and thrombolytic therapies compared with those without antithrombotic and thrombolytic therapies (OR 11.67, 95% CI 5.861-23.249). The major causes of death were sudden death, resistant shock in patients without antithrombotic and thrombolytic therapies while the causes were sudden death, cerebral hemorrhage and resistant shock in PE patients received antithrombotic and thrombolytic therapies. (3) Literatures on PE misdiagnosis were most from provincial hospitals [37 papers with 547 cases (33.6%, 35.5%)] and municipal hospitals [43 papers with 671 cases (39.1%, 43.6%)]. (4) The number of papers published on PE and PE misdiagnosis from 1994 to 2004 increased steadily by an average of 26.6% and 9.1%, respectively. (5) PE was misdiagnosed to more than 70 kinds of diseases and the top 4 were coronary heart disease in 449 cases (26.8%), pneumonia in 217 cases (12.9%), congestive heart failure in 142 cases (8.5%) and pleurisy in 114 cases (6.8%).

CONCLUSIONS(1) PE misdiagnosis is still a critical issue now in China and early diagnosis and effective treatment is essential for a better prognosis. (2) The differential diagnosis among PE and coronary heart disease and pneumonia need to be emphasized to avoid the PE misdiagnosis. (3) Efforts should be made through continuing education on clinical professionals to improve their knowledge on PE in China.