Physicians appear to place lower importance on factors that may lead to diagnosis of pulmonary embolism when evaluating patients with dementia who present with shortness of breath, a new study finds.
Investigators looked at emergency room visits for veterans aged 60 and over who were subsequently diagnosed with pulmonary embolism. The sample included more than 590,000 patient visits for shortness of breath fielded by 7124 emergency room physicians. About 6% of the patients had dementia, and 11% received pulmonary embolism testing.
Results showed that patients with dementia who had clinical risk factors for pulmonary embolism risk were less likely to be tested for pulmonary embolism than patients without dementia, reported Dan Ly, M.D., Ph.D., and Paul Shekelle, M.D., Ph.D., of VA Greater Los Angeles Healthcare System, Los Angeles.
Risk factors for pulmonary embolism accounted for in the study were deep venous thrombosis (DVT)/PE, malignancy, recent surgery and tachycardia. These were noted in the patients’ electronic health records.
It’s not clear why these risk factors were not taken into account, Ly and Shekelle wrote. Physicians either missed these clinical factors more often during patient evaluations, or recognized them but did not use them during the evaluation process, they said.
“Our results are consistent with the possibility that physicians are less able to identify important clinical factors in patients with dementia, and by not identifying the possibility of pulmonary embolism, are unable to discuss testing and treatment options with patients and their caregivers consistent with their care preferences,” they concluded.
Although the study did was not able to determine the reasons for the results, one possibility is that physicians may give lower weight to factors in the EHR that they cannot directly verify. Patients with dementia may be unable to convey important information about their present illness or medical history, for example.
“Further understanding how physicians evaluate patients with dementia presenting with common acute symptoms may help improve the care delivered to such patients,” they concluded.
The study was published in the Journal of the American Geriatrics Society.