Background: Pulmonary embolism (PE) remains one of the most serious complications of venous thrombosis, leading to adverse outcomes such as death, pulmonary hypertension, and right heart failure. The clinical presentation varies depending on the severity, ranging from mild dyspnea to severe hypoxemia and obstructive shock. However, there are also less specific or atypical symptoms that may not be directly attributed to PE, such as syncope or dizziness. Particularly in the prehospital setting, establishing an accurate diagnosis remains challenging, and there are currently no data evaluating the extent to which prehospital diagnostic accuracy influences patient-centered outcomes.
Methods: A single-center retrospective database analysis was conducted including all patients with PE between January 2019 and December 2024. All patients transferred to the hospital by emergency medical services (EMS) with a prehospital suspicion of PE were screened and those with a diagnosis of central PE were included in the analysis. Two groups were established to examine potential gender-related differences. EMS protocols were reviewed for suspected diagnosis, vital signs, clinical presentation, prehospital diagnostic and therapeutic measures. The primary endpoint was the concordance between the prehospital suspected diagnosis and the final confirmed diagnosis of PE (diagnostic sensitivity) between the two groups. Secondary endpoints included length of hospital stay, in-hospital mortality, and the potential impact of prehospital therapy on clinical outcomes.
Results: In total, 654 patients with PE were screened. Of these, 96 patients with severe central PE were included, comprising 46 women and 50 men. Male and female patients were of similar age (69.9 ± 13.4 years vs. 72.8 ± 16.2 years; p = 0.30) and had comparable hospital stays (9.1 ± 7.7 days vs. 9.3 ± 10.6 days; p = 0.90). The diagnostic sensitivity of prehospital PE recognition by EMS was low in the overall cohort (9.4%; 95% CI 4.4–16.9) without significant differences in diagnostic sensitivity between male and female patients (12.0%; 95% CI 4.5–24.9 vs. 6.5%; 95% CI 1.4–17.9; p = 0.49). Mortality was similar between groups (24% vs. 28%; p = 0.65), as was the need for cardiopulmonary resuscitation (4.0% vs. 4.3%; p = 0.42). Likewise, there was no statistically significant difference in the use of catheter-directed thrombolysis (14.0% vs. 21.7%; p = 0.42).
Conclusion: Central PE is markedly underdiagnosed in the prehospital emergency setting, with no significant sex-related differences. Mortality and the use of advanced therapies such as catheter-directed thrombolysis were comparable between male and female patients. The impact of prehospital diagnostic accuracy and treatment on patient outcomes warrants further investigation.
