Determinants for Positive Computed Tomography Pulmonary Angiography (Ctpa) in Diagnosing Pulmonary Embolism in Northeast State of Peninsular Malaysia

Abstract

Background: This study was conducted to estimate the annual proportion of positive computed tomography pulmonary angiography (CTPA) in diagnosing pulmonary embolism and determine its socio-demographic and clinical determinants. Materials and Methods: CTPA datasets of 431 patients from 2014 to 2017 were analysed retrospectively to estimate the annual proportion of cases with pulmonary embolism in Kelantan, a northeast state of peninsular Malaysia. Comparative cross-sectional study between positive and negative CTPA cases among 388 randomly selected patients that fulfilled the inclusion criteria was conducted to determine associated factors for positive CTPA finding. Descriptive statistics, simple and multiple logistic regressions were used for data analysis. Result: The annual proportion of positive CTPA cases ranged from 25.2% to 33.3%. The mean age of patients with positive CTPA finding was 50.32 years old and majority of positive CTPA patients were male (67.0 %), cigarette smoker (67.0 %), non-hypertensive (58.9%) and had high Well's score (74.5%). Older age, male gender and high Wells score were the significant determinants for positive CTPA findings with an adjusted odds ratio (aOR) of 1.03 (95% confidence interval (CI): 1.01-1.05; p = 0.004), 5.42 (95% CI: 2.31-12.68; p < 0.001), and 13.45 (95% CI: 6.93-26.11; p < 0.001), respectively. Conclusion: Patients with older age, male gender and high Wells score were more likely to get positive CTPA finding. These significant determinants might help clinicians in preventing unnecessary CTPA examination, thus unjustified radiation to the patient can be avoided.