Associated factors and survival following diagnostic delay of pulmonary embolism at a Southeast Asian emergency department

Abstract Pulmonary embolism (PE) is a life-threatening condition whose diagnosis is frequently delayed, particularly in settings with limited validated risk-stratification data. Diagnostic delay in Southeast Asia remains poorly characterised. This retrospective cohort study included 156 adults with CTPA-confirmed PE who presented to the emergency department at Hospital Shah Alam, Malaysia, between 2020 and 2024. We determined the detection rate of PE among adult ED visits and identified factors associated with diagnostic delay, defined as a symptom-to-diagnosis interval exceeding seven days. The detection rate was 39.50 per 100,000 adult ED visits (95% CI 33.42–45.82). Diagnostic delay occurred in 45.5% of cases (71/156), higher than the 18–38% reported internationally. In this exploratory multivariable analysis, a Wells’ score above four and obesity were associated with earlier diagnosis (adjusted odds ratio 0.38, 95% CI 0.17–0.87, p = 0.023; and 0.26, 95% CI 0.08–0.84, p = 0.025, respectively), while cough showed a similar but statistically less consistent association (aOR 2.48, p = 0.050) that was further attenuated in sensitivity analysis. Both pre-hospital and in-hospital intervals were longer among delayed cases. Delayed diagnosis was associated with longer hospital stay and lower six-month survival (46.7% vs. 67.2%, p = 0.036), though this exploratory analysis cannot establish causality. These findings highlight a substantial burden of diagnostic delay in this setting and support the development of locally validated risk-stratification tools for PE.