Mortality From Acute Pulmonary Embolism According to Season

Stein, Paul D.; Kayali, Fadi; Beemath, Afzal; Skaf, Elias; Alnas, Majd; Alesh, Issa; Olson, R. E.

doi:10.1016/s0012-3692(15)52872-9

Cited by 21 publications

(12 citation statements)

References 12 publications

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“…20 Although death certificate data may underestimate pulmonary embolism mortality, it can accurately estimate time trends and is routinely used for this purpose. 20,33,34 While our findings suggest there may be substantial overdiagnosis of pulmonary embolism, we cannot conclude that overdiagnosis explains the entire increase. Some of these "emboli" may represent false positive results; the PIOPED II trial found the positive predictive value of CTPA to be <60% in cases of low clinical suspicion for pulmonary embolism.…”

Section: Commentcontrasting

confidence: 60%

Time Trends In Pulmonary Embolism In The United States: Evidence Of Overdiagnosis?

Wiener

Schwartz

Woloshin³

2010

D14. Innovative Health Services Research to Improve Outcomes

211

272

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Section: Commentcontrasting

confidence: 60%

Time Trends In Pulmonary Embolism In The United States: Evidence Of Overdiagnosis?

Wiener

Schwartz

Woloshin³

2010

D14. Innovative Health Services Research to Improve Outcomes

211

272

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“…However, the existence of such variation is controversial. 38,39 In a previous study of a small number of cases we could not find a seasonal variation in Japan. 40 …”

Section: Study Limitationsmentioning

confidence: 66%

Potential Risk Factors and Incidence of Pulmonary Thromboembolism in Japan Results From an Overview of Mailed Questionnaires and a Matched Case - Control Study

Sugimura

Sakuma

Shirato

2006

Circ J

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eaths from pulmonary thromboembolism (PTE) have increased in Japan annually. 1 The numbers of symptomatic PTE patients were estimated in both 1996 and 2000, and tended to increase between those years. 2,3 Independent risk factors for PTE were proposed in the United States, 4 and their incidence in Japan has been reported; 2,3,5 however, the odds ratio (OR) of each factor has not been examined in Japan. Moreover, it is controversial whether cardiovascular risk factors are causally related to PTE. [6][7][8] Our aims for this present study were to assess the potential risk factors for PTE and to estimate the recent incidence of symptomatic PTE per year in Japan. MethodsThe present study was approved by the Ethics Committee of Tohoku University. In July 2004, we sent questionnaires to the clinical departments (all departments of internal medicine, surgery, pediatrics, psychiatry, obstetrics and gynecology, orthopedics, otorhinolaryngology, ophthalmology, dermatology and urology) of university schools of medicine or medical colleges and to hospitals with more than 100 beds in Japan. Based on the replies, we prospectively assessed the number of new patients with PTE from August 1, 2004 to September 30, 2004 and the potential risk factors for PTE (obesity, prolonged immobilization, recent major surgery, pregnancy/postpartum, recent major trauma/fracture, cancer, coagulation disorders, diabetes mellitus, hypertension, hyperlipidemia, smoking, and drinking). Each case of PTE was paired with a control case without PTE (matched for gender and age within 5 years, and admitted closest after the case). Alcohol consumption was calculated as g/day = amount of drink (ml/day) × concentration of alcohol (%) ×0.8 (g/ml)/100, where the concentration of alcohol in beer, wine, sake, shochu (Japanese distilled liquor), and whisky is 5%, 12%, 15%, 25%, and 40%, respectively, and 0.8 is the specific gravity of alcohol. The number of patients with PTE per year was calculated as the number of patients with PTE per year = the number of patients with PTE per 2 months ×6/the response rate. Definition of TermsPTE was definitely diagnosed by (1) enhanced computed tomography, (2) pulmonary angiography, (3) pulmonary perfusion scintigraphy and/or pulmonary ventilation scintigraphy, (4) magnetic resonance imaging, or (5) autopsy. Acute PTE was defined as acute onset of less than 2 weeks. Chronic thromboembolic pulmonary hypertension (CTEPH) was defined as stable pulmonary thromboembolic lesions for 6 months or longer with a mean pulmonary artery pressure greater than 25 mmHg, and pulmonary capillary wedge pressure less than 12 mmHg. 9,10 Chronic PTE was the cases that did not satisfy the criteria for acute PTE or CTEPH and

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“…20 Although death certificate data may underestimate pulmonary embolism mortality, it can accurately estimate time trends and is routinely used for this purpose. 20, 33, 34 …”

Section: Commentmentioning

confidence: 99%

Time Trends in Pulmonary Embolism in the United States

Wiener

Schwartz²,

Woloshin³

2011

Arch Intern Med

462

207

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Background Computed tomography pulmonary angiography (CTPA) may improve detection of life-threatening pulmonary embolism. But this sensitive test may have a downside: overdiagnosis and overtreatment (finding clinically unimportant emboli and exposing patients to harms from unnecessary treatment). Methods To assess the impact of CTPA on national pulmonary embolism incidence, mortality, and treatment complications, we conducted a time trend analysis using the Nationwide Inpatient Sample and Multiple Cause-of-Death databases. We compared age-adjusted incidence, mortality, and treatment complications (in-hospital gastrointestinal or intracranial hemorrhage or secondary thrombocytopenia) of pulmonary embolism among United States adults before (1993–1998) and after (1998–2006) CTPA was introduced. Results Pulmonary embolism incidence was unchanged before CTPA (p=0.63), but increased substantially after CTPA (81% increase: from 62.1 to 112.3 per 100,000, p<0.001). Pulmonary embolism mortality decreased during both periods: more so before CTPA (8% reduction: from 13.4 to 12.3 per 100,000, p<0.001) than after (3% reduction: from 12.3 to 11.9 per 100,000, p=0.02). Case-fatality improved slightly before (8% decrease, from 13.2% to 12.1%, p=0.02) and substantially after CTPA (36% decrease: from 12.1% to 7.8%, p<0.001). Meanwhile, CTPA was associated with an increase in presumed complications of anticoagulation for pulmonary embolism: pre-CTPA, the complication rate was stable (p=0.24), but post-CTPA it increased by 71% (from 3.1 to 5.3 per 100,000, p<0.001). Conclusions The introduction of CTPA was associated with changes consistent with overdiagnosis: rising incidence, minimal change in mortality, and lower case-fatality. Better technology allows us to diagnose more emboli, but to minimize harms of overdiagnosis we must learn which ones matter.

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Mortality From Acute Pulmonary Embolism According to Season

Cited by 21 publications

References 12 publications

Time Trends In Pulmonary Embolism In The United States: Evidence Of Overdiagnosis?

Time Trends In Pulmonary Embolism In The United States: Evidence Of Overdiagnosis?

Potential Risk Factors and Incidence of Pulmonary Thromboembolism in Japan Results From an Overview of Mailed Questionnaires and a Matched Case - Control Study

Time Trends in Pulmonary Embolism in the United States

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