Diagnostic yield and renal complications after computed tomography pulmonary angiograms performed in a community-based academic hospital

Autor:	Narinder Gill, Zacharia Reagle, Steven Tringali, Michael W. Peterson
Přispěvatelé:	UCSF-Fresno Medical Education Program, Community Medical Centers, Fresno California, USA
Jazyk:	angličtina
Rok vydání:	2012
Předmět:	medicine.medical_specialty lcsh:Internal medicine pulmonary embolism venous thromboembolism Contrast-induced nephropathy computed tomography pulmonary angiogram Nephropathy chemistry.chemical_compound contrast induced nephropathy Diabetes mellitus Internal Medicine medicine Venous Thromboembolism Pulmonary Embolism Computed Tomography Pulmonary Angiograms Contrast Induced Nephropathy Medical diagnosis lcsh:RC31-1245 Creatinine business.industry Original research Emergency department medicine.disease Community hospital Pulmonology Pulmonary embolism chemistry Radiology business Research Article
Zdroj:	Journal of Community Hospital Internal Medicine Perspectives, Vol 2, Iss 2, Pp 1-6 (2012) Journal of Community Hospital Internal Medicine Perspectives; Vol 2, No 2 (2012) Journal of Community Hospital Internal Medicine Perspectives
ISSN:	2000-9666
Popis:	Background: Venous thromboembolism and pulmonary embolism (VTE/PE) remain a diagnostic challenge. The computed tomography pulmonary angiogram (CTPA) has emerged as a popular diagnostic test for PE. However, there is limited data on diagnostic yield and complications in actual clinical settings. Our goal was to determine the diagnostic yield for PE and rate of renal complications following CTPA in a large community hospital setting. Methods: A retrospective chart review of 1,514 patients who underwent CTPA in the emergency department or during the initial 24 hours of admission to a community-based academic hospital. Results: Of 1,514 CTPAs, 125 were positive for VTE/PE yielding a positive diagnosis in 8.2%. Dyspnea was the most common symptom in patients and a normal physical exam was the most common finding. Among the 925 patients with adequate data to calculate the rate of contrast-induced nephropathy (CIN), 25.8% had an increase of at least 25% in serum creatinine following the CTPA. Pre-existing diabetes and age were the most important predictors of CIN. Conclusions: CTPA has a low diagnostic yield for PE in a community setting, and in some patient populations, the rate of contrast-induced nephropathy may be higher than previously reported in the literature. Due to the retrospective nature of this study we were limited in using pre-test scoring systems and in measuring the impact of alternative CT diagnoses on patient management. Keywords: venous thromboembolism; pulmonary embolism; computed tomography pulmonary angiogram; contrast induced nephropathy (Published: 16 July 2012) Citation: Journal of Community Hospital Internal Medicine Perspectives 2012, 2 : 17722 - http://dx.doi.org/10.3402/jchimp.v2i2.17722
Databáze:	OpenAIRE
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