Overdiagnosis of Pulmonary Embolism by Pulmonary CT Angiography

Hutchinson, Barry; Navin, Patrick J.; Marom, Edith M.; Truong, Mylene T.; Bruzzi, John F.

doi:10.2214/ajr.14.13938

Cited by 145 publications

(111 citation statements)

References 24 publications

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“…7 Other studies have indicated that the difficulty of interpreting radiographic studies may result in overdiagnosis of PEs by pulmonary computed tomography angiography. 8 Our data also demonstrate an increase in pulmonary imaging in children with VTEs. With these data, it is not possible to determine whether these tests were obtained in response to significant clinical symptoms, but it is possible that the increase in diagnosis of PEs is related, at least in part, to the increased use of imaging.…”

Section: Discussionsupporting

confidence: 63%

Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014

2018

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Key Points• Rates of pediatric PE in hospitalized patients increased 184% from 2001 to 2014.• Mortality as a result of PE in children has decreased over time and is now comparable to that from VTE.Although rare in children, pulmonary embolism (PE) can cause significant morbidity and mortality. Overall rates of venous thromboembolism (VTE) are increasing in hospitalized children. By using the Pediatric Health Information System database, we evaluated incidence, treatment, and outcome of PE in children younger than age 18 years from 2001 to 2014.Demographic characteristics for those admitted with VTE alone and those admitted with PE were compared. Rates of PE by year were compared with the number of hospital and VTE admissions. Trends in medication use were analyzed. Over the period of the study, patients with PE made up 15.8% of VTE discharges. The overall rate of PE increased 200%(P , .001). Compared with all other age groups, adolescents (age 13-18 years) had the highest prevalence (55%; P , .001), the rate of which increased from 9.8 to 24.7 per 10 000 hospital discharges (152%; P , .001), and from 17.5 to 34.1 per 100 VTE discharges (95%; P , .001). Individuals with PE had a higher mortality (8.3% vs 6%; P , .001) and were less likely to have a complex chronic condition (58% vs 65%; P , .001) than those with VTE alone. However, PE mortality rates decreased over the time period studied. AfricanAmerican and Hispanic patients were more likely to experience recurrent PE than white patients (12% and 10.7% vs 8%; P 5 .002). During the study period, the use of unfractionated heparin decreased (P , .001), and the use of low molecular weight heparin increased (P , .001). Further research is required to determine what factors contribute to the higher rate of PE in adolescents and influence recurrence in African American and Hispanic patients.

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Section: Discussionsupporting

confidence: 63%

Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014

2018

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“…This rate is much higher than that in other recent studies. 24,25 This may be attributed to our patient group being at greater risk of PE compared to the general population receiving contrast-enhanced CTPA since our patients were selected from among subjects with at least one risk factor for CIN. At the same time, current knowledge shows that PEs diagnosed by contrast enhanced CTPA are frequently overdiagnosed.…”

Section: Discussionmentioning

confidence: 99%

The High Risk of Contrast‐induced Nephropathy in Patients with Suspected Pulmonary Embolism Despite Three Different Prophylaxis: A Randomized Controlled Trial

Türedi

Erdem

Karaca

et al. 2016

Academic Emergency Medicine

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Objective: The objective was to compare the protective effects of N-acetylcysteine (NAC) plus normal saline (NS), sodium bicarbonate (NaHCO 3 ) plus NS, and NS alone in the prevention of contrast-induced nephropathy (CIN) after computed tomography pulmonary angiography (CTPA) in emergency patients.Methods: This study was planned as a randomized, controlled clinical research. Patients undergoing contrast-enhanced CTPA on suspicion of pulmonary embolism (PE) in the emergency department and with at least one risk factor for development of CIN were included in one of three different prophylaxis groups. The groups received 3 mL/kg intravenous (IV) NAC+NS or NaHCO 3 +NS solution or NS alone 1 hour before CTPA and 1 mL/kg IV per hour for a minimum of 6 hours after CTPA. CIN was evaluated as the primary outcome and moderate or severe renal insufficiency and in-hospital mortality as secondary outcomes.Results: A total of 257 patients were enrolled in the study. The total level of CIN development was 23.7% (61/257), the level of moderate and severe renal failure was 12.5% (32/257), and the in-hospital mortality rate was 12.8% (33/257). Rates of CIN development in the drug groups were 23.5% in the NAC group (20/ 85), 21.2% (18/85) in the NaHCO 3 group, and 26.4% in the NS group (23/87). Rates of development of moderate or severe renal insufficiency were 9.4% in the NAC group (8/85), 10.6% in the NaHCO 3 group (9/ 85), and 17.2% in the NS group (15/87). In-hospital mortality rates were 12.9% in the NAC group (11/85), 11.8% in the NaHCO 3 group (10/85), and 13.8% in the NS group (12/87). No difference was determined between the drug groups in terms of CIN, moderate or severe renal injury, or hospital mortality. Conclusions:Our results indicate that there is a high risk of CIN in patients with suspected PE despite three different types of prophylaxis being administered, and no statistically significant differences were observed among prophylactic NAC, NaHCO 3 , and NS in prevention of CIN following contrast-enhanced CTPA.

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“…As reported in a multiyear nationwide analysis [1], the introduction of computed tomography pulmonary angiography (CTPA) was associated with overdiagnosis and overtreatment of pulmonary embolism (PE): rising incidence, minimal change in mortality, and lower case fatality. CTPA can overdiagnose small subsegmental, nonocclusive PE [2], which may not require treatment, especially when patients have bleeding risk, as in this case…”

Section: Compliance With Ethical Standardsmentioning

confidence: 93%

Scintigraphic Evidence for Overdiagnosis of Small PE on CT Pulmonary Angiography

Lü

2015

Nucl Med Mol Imaging

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A 68-year-old man with recent history of a fall presented with dyspnea on exertion, and underwent computed tomography pulmonary angiography (CTPA) for possible pulmonary embolism (PE). The CTPA was first read by the radiology resident as nondiagnostic for segmental PE. Subsequent planar perfusion (Q) images were normal; meanwhile, the attending radiologist revised the CTPA results as subsegmental PE in the left upper lobe. Further Q-SPECT images were obtained and fused with CTPA for clarification, which showed normal perfusion in the region of PE. The patient was monitored without anticoagulation treatment and remained uneventful for 12 months. This case illustrates that CTPA can lead to overdiagnosis and overtreatment of nonocclusive subsegmental PE.Keywords Pulmonary embolism . Computed tomography pulmonary angiography . V/Q scan . Perfusion SPECT/CT . Overdiagnosis Fig. 1 A 68-year-old man with history of a fall 2 weeks previously, presented with dyspnea on exertion and oxygen saturation of 87 % on room air. To rule out possible PE, CTPA was ordered and initially read by the oncall radiology resident as Bnon-diagnostic for segmental or subsegmental PE.^To obtain definitive diagnosis, further planar perfusion (Q) images were obtained about 1 h later and showed normal perfusion in both lungs

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Overdiagnosis of Pulmonary Embolism by Pulmonary CT Angiography

Cited by 145 publications

References 24 publications

Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014

Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014

The High Risk of Contrast‐induced Nephropathy in Patients with Suspected Pulmonary Embolism Despite Three Different Prophylaxis: A Randomized Controlled Trial

Scintigraphic Evidence for Overdiagnosis of Small PE on CT Pulmonary Angiography

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