Incidental Findings on Computed Tomography Angiography in Patients Evaluated for Pulmonary Embolism

Perelas, Apostolos; Dimou, Anastasios; Saenz, Augustina; Rhee, Ji Hyun; Teerapuncharoen, Krittika; Rowden, Adam K.; Eiger, Glenn

doi:10.1513/annalsats.201404-144oc

Cited by 29 publications

(49 citation statements)

References 14 publications

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“…However, an additional 5% of CT patients receive months of anticoagulation and carry the medical diagnosis of PE for the rest of their lives, increasing insurance costs and probably individual patient anxiety. Incidental findings such as pulmonary nodules or adrenal masses are common with advanced imaging, particularly in older individuals . These “incidentalomas” can lead to significant additional downstream testing .…”

Section: Relevance Of “Preventing Overdiagnosis” For Emergency Medicinementioning

confidence: 99%

Overtesting and the Downstream Consequences of Overtreatment: Implications of “Preventing Overdiagnosis” for Emergency Medicine

Carpenter

Raja

Brown

2015

Academic Emergency Medicine

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Overtesting, the downstream consequences of overdiagnosis, and overtreatment of some patients are topics of growing debate within emergency medicine (EM). The "Preventing Overdiagnosis" conference, hosted by The Dartmouth Institute for Health Policy and Clinical Practice, with sponsorship from consumer organizations, medical journals, and academic institutions, is evidence of an expanding interest in this topic. However, EM represents a compellingly unique environment, with increased decision density tied to high stakes for patients and providers with missed or delayed diagnoses in a professional atmosphere that does not tolerate mistakes. This article reviews the relevance of this reductionist paradigm to EM, provides a first-hand synopsis of the first "Preventing Overdiagnosis" conference, and assesses barriers to moving the concept of less test ordering to reality.

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Section: Relevance Of “Preventing Overdiagnosis” For Emergency Medicinementioning

confidence: 99%

Overtesting and the Downstream Consequences of Overtreatment: Implications of “Preventing Overdiagnosis” for Emergency Medicine

Carpenter

Raja

Brown

2015

Academic Emergency Medicine

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“…( 20 ) In addition, the role played by chest CTA in the absence of PTE in making alternative diagnoses that were missed by simple tests, such as chest X-ray, has not been fully investigated. ( 18 - 20 )…”

Section: Introductionmentioning

confidence: 99%

Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism

et al. 2016

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Objective: To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods: This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results: On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions: Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients.

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“…There are risks of false‐positive findings when the interpreting physician, who can be the radiologist or the ED physician, misreads an imaging test . Incidental findings are particularly concerning, given the downstream testing that may be unnecessary and can occur as a result . Intravenous contrast carries a risk of acute kidney injury and of allergic reactions .…”

Section: Current State Of Diagnostic Imagingmentioning

confidence: 99%

Developing a Research Agenda to Optimize Diagnostic Imaging in the Emergency Department: An Executive Summary of the 2015 Academic Emergency Medicine Consensus Conference

Marin

Mills

2015

Academic Emergency Medicine

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The 2015 Academic Emergency Medicine (AEM) consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization," was held on May 12, 2015, with the goal of developing a high-priority research agenda on which to base future research. The specific aims of the conference were to: 1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging utilization and identify key opportunities, limitations, and gaps in knowledge; 2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and 3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Over a 2-year period, the executive committee and other experts in the field convened regularly to identify specific areas in need of future research. Six content areas within emergency diagnostic imaging were identified prior to the conference and served as the breakout groups on which consensus was achieved: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use. The executive committee invited key stakeholders to assist with planning and to participate in the consensus conference to generate a multidisciplinary agenda. There were 164 individuals involved in the conference spanning various specialties, including emergency medicine (EM), radiology, surgery, medical physics, and the decision sciences. This issue of AEM is dedicated to the proceedings of the 16th annual AEM consensus conference as well as original research related to emergency diagnostic imaging.

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Incidental Findings on Computed Tomography Angiography in Patients Evaluated for Pulmonary Embolism

Abstract: CT angiography is superior to chest radiography at providing a diagnosis in patients investigated for PE, even when no PE is present. However, in patients at low risk for PE, the clinical benefit of the additional diagnoses is questionable.

Cited by 29 publications

References 14 publications

Overtesting and the Downstream Consequences of Overtreatment: Implications of “Preventing Overdiagnosis” for Emergency Medicine

Overtesting and the Downstream Consequences of Overtreatment: Implications of “Preventing Overdiagnosis” for Emergency Medicine

Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism

Developing a Research Agenda to Optimize Diagnostic Imaging in the Emergency Department: An Executive Summary of the 2015 Academic Emergency Medicine Consensus Conference

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