Overdiagnosis of Pulmonary Embolism: Evaluation of a Hypoxia Algorithm Designed to Avoid This Catastrophic Problem

Autor: James J. Purtill, Christina Jacovides, Brian S. Winters, Javad Parvizi, Mark Solarz, Richard H. Rothman
Jazyk: angličtina
Rok vydání: 2011
Předmět:
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Perfusion Imaging
Perfusion scanning
Ventilation/perfusion ratio
Sensitivity and Specificity
Predictive Value of Tests
Ventilation-Perfusion Ratio
Medicine
Humans
Orthopedics and Sports Medicine
cardiovascular diseases
Overdiagnosis
Arthroplasty
Replacement
Symposium: Papers Presented at the Annual Meetings of The Hip Society
Hypoxia
Retrospective Studies
Philadelphia
Chi-Square Distribution
business.industry
Incidence
Retrospective cohort study
General Medicine
Hypoxia (medical)
medicine.disease
Prognosis
Arthroplasty
Pulmonary embolism
Cross-Sectional Studies
Predictive value of tests
cardiovascular system
Surgery
Radiology
medicine.symptom
business
Pulmonary Embolism
Tomography
X-Ray Computed
Algorithms
Program Evaluation
Popis: We observed a substantial increase in the incidence of pulmonary embolism (PE) after total joint arthroplasty (TJA) when multidetector computerized tomography (MDCT) replaced ventilation-perfusion (V/Q) scans as the diagnostic modality of choice. We questioned whether this resulted from the detection of clinically unimportant PE with the more sensitive MDCT and in 2007 instituted a hypoxia protocol to enhance the detection of PE.We determined whether this new hypoxia protocol increased the specificity of our workups for suspected clinically important PE in the immediate postoperative period without affecting patient morbidity and mortality.We compared the frequency of MDCT, V/Q scan and total investigations, incidence of PE, and overall mortality rates in the 3 years prior (January 2003 to December 2006) and 2 years after (January 2007 to November 2009) the implementation of the algorithm.After instituting the protocol, we observed a trend toward a decrease in the number of patients worked up for PE (4.6 to 4.0 per 100 TJAs, 13.5% decrease). At the same time, there was an increase in the percent of positive findings of PE per workup for PE (23-33 positive PEs per 100 patients, 40.5% increase). All-cause mortality rates decreased for the 30-day period (3.1 to 1.4 per 1000 TJAs, 53.5% decrease) and the 90-day period (5.0 to 2.6 per 1000 TJAs, 48.3% decrease).With the implementation of this algorithm, the specificity of our management of postoperative hypoxia and suspected clinically important PE improved without affecting patient morbidity or mortality.
Databáze: OpenAIRE
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