CT pulmonary angiography: an over-utilized imaging modality in hospitalized patients with suspected pulmonary embolism
| Autor: | Gloria T. Fioravanti, Mohamed Turki, Madhu Badireddy, Sunil Kumar, Erin Smith, Penchala Mittadodla |
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| Rok vydání: | 2013 |
| Předmět: |
lcsh:Internal medicine
medicine.medical_specialty Ct pulmonary angiography diagnosis of PE Hospitalized patients business.industry CT pulmonary angiography Suspected pulmonary embolism medicine.disease CTPA over utilization Community hospital Pulmonary embolism acute pulmonary embolism PE Pre- and post-test probability Venous thrombosis Internal Medicine medicine Pulmonary angiography Radiology Pulmonary Embolism lcsh:RC31-1245 business Research Article |
| Zdroj: | Journal of Community Hospital Internal Medicine Perspectives, Vol 3, Iss 1, Pp 1-4 (2013) Journal of Community Hospital Internal Medicine Perspectives; Vol 3, No 1 (2013) Journal of Community Hospital Internal Medicine Perspectives |
| ISSN: | 2000-9666 |
| Popis: | Aims: To determine if computed tomographic pulmonary angiography (CTPA) was overemployed in the evaluation of hospitalized patients with suspected acute pulmonary embolism (PE). Methods: Data were gathered retrospectively on hospitalized patients (n=185) who had CTPA for suspected PE between June and August 2009 at our institution. Results: CTPA was done in 185 hospitalized patients to diagnose acute PE based on clinical suspicion. Of these, 30 (16.2%) patients were tested positive for acute PE on CTPA. The Well’s pretest probability for PE was low, moderate, and high in 77 (41.6%), 83 (44.9%), and 25 (13.5%) patients, respectively. Out of the 30 PE-positive patients, pretest probability was low in 2 (6.6%), moderate in 20 (66.7%), and high in 8 (26.6%) (p=0.003). Modified Well’s criteria applied to all patients in our study revealed 113 (61%) with low and 72 (39%) with high clinical pretest probability. When modified Well’s criteria was applied to 30 PE-positive patients, 10 (33.3%) and 20 (66.6%) were found to have low and high pretest probability, respectively (p= 0.006). D-dimer assay was done in 30 (16.2%) of the inpatients with suspected PE and all of them were found to have elevated levels. A lower extremity duplex ultrasound confirmed deep venous thrombosis in 17 (9.1%) of the patients with suspected PE, at least 1 week prior to having CTPA. Conclusion: Understanding the recommended guidelines, evidence-based literature, and current concepts in evaluation of patients with suspected acute PE will reduce unnecessary CTPA examinations. Keywords: acute pulmonary embolism; PE; diagnosis of PE; CT pulmonary angiography; CTPA over utilization (Published: 17 April 2013) Citation: Journal of Community Hospital Internal Medicine Perspectives 2013, 3 : 20240 - http://dx.doi.org/10.3402/jchimp.v3i1.20240 |
| Databáze: | OpenAIRE |
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