Overuse and underuse of pulmonary CT angiography in patients with suspected pulmonary embolism

Abstract

Background: The aim of the present study was to evaluate the utilization and diagnostic yields of CT pulmonary angiography (CTPA)using the Revised Geneva score and Wells’ criteria, in patients with suspected pulmonary embolism (PE). Methods: One hundred and twelve adult patients underwent CTPA for suspected PE were participated in this study. The outcome was positive or negative CTPA for PE. Revised Geneva and Wells’ scores were calculated. The relationship between the results obtained rom these two scores and the available risk factors were compared. Descriptive analysis such as frequency and mean as well as analytical statistics including chi-square were done. The data analysis was performed using SPSS (v. 22). Results: In this study, according to the Wells’ criteria calculated for the patients, 33.9% of the patients had low clinical, 56.3% intermediate and 9.8% high clinical probability. Among the 11 high clinical patients, 9(81.8%) were CTPA positive. Based on the revised Geneva score, 65 patients (58%) had low clinical, 36 (32.1%) intermediate and 11(9.8%) high clinical probability. Among the 1 high clinical patients, 8 were CTPA positive. Positive predictive value of the low clinical patients based on Wells’ criteria and the revised Geneva score was 18.4% and 30.8%, respectively. Also, positive predictive value for high clinical probability of Wells’ criteria and the revised Geneva score was 81.8% and 72.8% respectively. Conclusion: Under/overuse of CTPA in diagnosing PTE is a common problem especially in university hospitals. It is possible to avoid unnecessary CTPA requests using scholarly investigations and more accurate clinical risk assessments.

COVID-19 and Pulmonary Thrombosis—An Unresolved Clinical Puzzle: A Single-Center Cohort Study

“…While D-dimer are typically increased in patients with COVID-19 and their levels are even higher in patients with PT, the threshold to differentiate COVID-19 patients with and without PT has not been widely accepted [ 8 ]. Notably, there is a lack of precise diagnostic guidelines for computed tomography pulmonary angiography (CTPA) [ 9 , 10 ]. Imaging studies show that thrombotic lesions are mostly located in the peripheral rather than in the main pulmonary arteries, which suggests a different pathophysiological mechanism [ 11 ].…”

Massive pulmonary embolism heart failure: A review of clinical status and meta-analyses of clinical scoring system and D-dimer, and thrombolytic and anticoagulation therapies

“…MPE is considered in the differential diagnosis of many clinical presentations and in a wide variety of clinical settings. In particular, non-specificity and non-sensitivity of clinical signs and symptoms has led to a low threshold for suspicion and increased referral for CT angiography [99]. However, only a small proportion (~10-15%) of all suspected cases are confirmed during CTA diagnostic investigation [64].…”

Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA)

“…Moreover, if the CTPA is regular in patients with low or intermediate clinical probability, the diagnosis of PE can be ruled out without further testing (Class IA) [5]. On the other hand, over-testing for PE remains a major health problem, especially in University hospitals [6,7]. In fact, it is estimated that 9.4% of CTPA could be avoided [8].…”