62 Trends in Use of Chest Computed Tomography With Angiography for Diagnosis of Pulmonary Embolism

Weiner, Scott G.; Gordon, Andrew; Moon, T.; Patel, M.; Shah, Sharan; Casey, Erin M.

doi:10.1016/j.annemergmed.2012.06.341

Cited by 33 publications

(46 citation statements)

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“…Three other studies of similar size report CTPAs positive for PEs in their cohort to be around 10% and similarly highlight CTPA use as a screening rather than diagnostic test [20][21][22]. So relative to other studies, our centre does well with a result of 15% of CTPAs being positive for PE.…”

Section: Discussionsupporting

confidence: 55%

Audit on the use of CTPA in pulmonary embolism (PE) diagnosis

Anwar¹,

Wong²,

Muza³

2017

Gen Int Med Clin Innov

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Section: Discussionsupporting

confidence: 55%

Audit on the use of CTPA in pulmonary embolism (PE) diagnosis

Anwar¹,

Wong²,

Muza³

2017

Gen Int Med Clin Innov

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“…There may be several reasons why the number of ED visits by patients with a primary diagnosis of VTE may be increasing or may not have declined. One reason is that the availability and utilization of comparatively newer diagnostic procedures for diagnosis of VTE have increased in the past several years [13][14][15] and this has probably resulted in greater recognition of VTE occurrences. For example, a study by Kocher et al found that between 1996 and 2007 the use of CT scans in emergency departments across the U.S. more than tripled; it increased by more than 5 times respectively among patients presenting with chest pain and patients presenting with shortness of breath [15] .…”

Section: Discussionmentioning

confidence: 99%

Emergency department visits by patients with venous thromboembolism, 1998-2009

Yusuf¹,

Tsai²,

Siddiqi³

et al. 2012

JHA

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Background: Substantial morbidity and mortality may result from venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Many VTE cases are diagnosed in outpatient settings, such as emergency departments. The purpose of this study was to estimate and characterize emergency department visits by patients with a primary diagnosis of VTE. Methods:Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years 1998-2009 were analyzed. NHAMCS uses a complex multistage design to sample non-federal short-term care hospitals across the United States. Emergency department visits with a primary diagnosis of VTE were identified using ICD-9-CM codes indicating a primary diagnosis of DVT or PE.Results: Between 2006-2009, an annual average of 201,000 (95% confidence interval [CI]: 152,000-251,000) emergency department visits were made in the U.S. by patients with a primary diagnosis of VTE as per the criteria used in this study, which was a rate of approximately 67 (95% CI 50-83) per 100,000 population. The rates during 1998-2001 and 2002-2005 were 31 (95% CI 21-40) and 46 (95% CI 35-57), respectively. The rate of visits with a primary diagnosis of VTE was higher among patients >61 years of age, when compared to younger patients. Among visits between 1998-2009, selected characteristics that differed between visits by patents with and without a primary diagnosis of VTE included the patient having been discharged from a hospital in the past seven days (11.7%, vs. 2.1%, p<0.01). Conclusion:A substantial number of emergency department visits are made by patients with a primary diagnosis of VTE. Groups with higher likelihood of VTE related visits may include older adults and those recently discharged from a hospital.

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“…(36). Clinical decision rules (CDRs) that use pretest probability estimations for the presence of PE are highly effective in selecting patients for further work-up by CTPA.…”

Section: Main Pointsmentioning

confidence: 99%

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Doğan

A²,

Geleijins³

et al. 2015

Diagn Interv Radiol

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A cute pulmonary embolism (PE) is the third most common cardiovascular condition, after coronary artery disease and stroke (1). Due to lack of specific sets of symptoms that accurately predict or exclude the diagnosis of acute PE, the diagnosis strongly relies on noninvasive imaging techniques. Diagnostic strategies for evaluating PE have undergone important changes over the past decades (2). Due to rapid technical advances in speed and spatial resolution, the utility of computed tomography (CT) angiography has been recognized in vascular imaging. Particularly, after the development of multidetector row CT in 1998 (3), CT pulmonary angiography (CTPA) has become the imaging method of choice in the diagnosis of acute PE (4). CTPA has advantages over conventional invasive X-ray pulmonary angiography and nuclear ventilation-perfusion (V/Q) imaging. CT is a widely available, fast and noninvasive technique, has the capability to directly visualize emboli, and may provide alternative diagnoses (4).Despite adequate diagnosis and anticoagulant therapy, death rate after a diagnosis of acute PE is still 8%-15% (5, 6). The prognosis of acute PE mainly depends on residual pulmonary circulation and the severity of right ventricular (RV) dysfunction (7). Recent studies have shown that CT permits the assessment of acute right-sided heart failure. Furthermore, CT can predict adverse clinical outcome by using the RV/left ventricular (LV) diameter ratio (8, 9) or RV ejection fraction in patients with PE (10).The aim of this review is to discuss the developments of CT in PE diagnosis, and to analyze the added value of CT in estimating PE severity and prognosis. Furthermore, CT findings of chronic thromboembolic pulmonary arterial hypertension (CTEPH) as a complication of acute PE will be discussed. CT developments in PE diagnosisHistorically, pulmonary angiography and nuclear planar V/Q-imaging were the main imaging methods used for diagnosing PE. Both methods have recognized limitations. Pulmonary angiography has previously been regarded as reference standard, but the method CHEST IMAGING REVIEW ABSTRACT Pulmonary embolism (PE) is a potentially life threatening condition requiring adequate diagnosis and treatment. Computed tomography pulmonary angiography (CTPA) is excellent for including and excluding PE, therefore CT is the first-choice diagnostic imaging technique in patients suspected of having acute PE. Due to its wide availability and low invasiveness, CTPA tends to be overused. Correct implementation of clinical decision rules in diagnostic workup for PE improves adequate use of CT. Also, CT adds prognostic value by evaluating right ventricular (RV) function. CT-assessed RV dysfunction and to lesser extent central emboli location predicts PE-related mortality in normotensive and hypotensive patients, while PE embolic obstruction index has limited prognostic value. Simple RV/left ventricular (LV) diameter ratio measures >1.0 already predict risk for adverse outcome, whereas ratios <1.0 can safely exclude adverse outcome. Con...

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62 Trends in Use of Chest Computed Tomography With Angiography for Diagnosis of Pulmonary Embolism

Cited by 33 publications

References 0 publications

Audit on the use of CTPA in pulmonary embolism (PE) diagnosis

Audit on the use of CTPA in pulmonary embolism (PE) diagnosis

Emergency department visits by patients with venous thromboembolism, 1998-2009

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

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