Venous Thromboembolic Disease

Stein, Paul D.; Hull, Russell D.; Patel, Kalpesh C.; Olson, R. E.; Ghali, William A.; Alshab, Andrew K.; Meyers, Frederick A.

doi:10.1001/archinte.163.14.1689

Cited by 39 publications

(7 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This and other studies also found that women who undergo imaging are 35%–55% less likely to be diagnosed with PE compared to similarly aged men 28–30 . Older data consistently demonstrate this trend as well, showing that women were more likely to undergo lung ventilation/perfusion scintigraphy (V/Q) for PE 37 . This is a particular problem among younger women, who are tested at nearly the same rates as older women despite having a considerably lower risk of PE 30 …”

Section: Introductionsupporting

confidence: 55%

“…[28][29][30] Older data consistently demonstrate this trend as well, showing that women were more likely to undergo lung ventilation/perfusion scintigraphy (V/Q) for PE. 37 This is a particular problem among younger women, who are tested at nearly the same rates as older women despite having a considerably lower risk of PE. 30 It is unclear why women are tested for PE in higher numbers than men, and it is not known if the unequal application of clinical decision tools by sex may explain some of the disparity in testing for PE.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Sex differences in guideline‐consistent diagnostic testing for acute pulmonary embolism among adult emergency department patients aged 18–49

Jarman

Mumma

White

et al. 2023

Academic Emergency Medicine

View full text Add to dashboard Cite

BackgroundPulmonary embolism (PE) is a frequent diagnostic consideration in emergency department (ED) patients, yet diagnosis is challenging because symptoms of PE are nonspecific. Guidelines recommend the use of clinical decision tools to increase efficiency and avoid harms from overtesting, including D‐dimer screening in patients not at high risk for PE. Women undergo testing for PE more often than men yet have a lower yield from testing. Our study objective was to determine whether patient sex influenced the odds of received guideline‐consistent care.MethodsWe performed a retrospective cohort study at two large U.S. academic EDs from January 1, 2016, to December 31, 2018. Nonpregnant patients aged 18–49 years were included if they presented with chest pain, shortness of breath, hemoptysis, or syncope and underwent testing for PE with D‐dimer or imaging. Demographic and clinical data were exported from the electronic medical record (EMR). Pretest risk scores were calculated using manually abstracted EMR data. Diagnostic testing was then compared with recommended testing based on pretest risk. The primary outcome was receipt of guideline‐consistent care, which required an elevated screening D‐dimer prior to imaging in all non–high‐risk patients.ResultsWe studied 1991 discrete patient encounters; 37% (735) of patients were male and 63% (1256) were female. Baseline characteristics, including revised Geneva scores, were similar between sexes. Female patients were more likely to receive guideline‐consistent care (70% [874/1256] female vs. 63% [463/735] male, p < 0.01) and less likely to be diagnosed with PE (3.1% [39/1256] female vs. 5.3% [39/735] male, p < 0.05). The most common guideline deviation in both sexes was obtaining imaging without a screening D‐dimer in a non–high‐risk patient (75% [287/382] female vs. 75% [205/272] male).ConclusionsIn this cohort, females were more likely than males to receive care consistent with current guidelines and less likely to be diagnosed with PE.

show abstract

Section: Introductionsupporting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Sex differences in guideline‐consistent diagnostic testing for acute pulmonary embolism among adult emergency department patients aged 18–49

Jarman

Mumma

White

et al. 2023

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Stein et al reported that the incidence of PE among hospitalized adults aged ≥20 years did not change during the 1979 to 1999 period [1]. In addition, he also found that the diagnosis rate decreased over that period [30]. Lilienfeld et al reported that the population mortality for PE declined over the same period [31].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Embolism Incidence and Fatality Trends in Chinese Hospitals from 1997 to 2008: A Multicenter Registration Study

et al. 2011

View full text Add to dashboard Cite

BackgroundThere has not been sufficient evidence to support the Asians being less susceptible to pulmonary embolism (PE) than other ethnicities, because the prevalence of PE/deep venous thrombosis (DVT) in different racial and ethnic groups has not been carefully studied until recently except in Caucasians. To test the hypothesis that the Chinese population has a lower risk for PE, this study comprehensively assessed the hospital-based incidence and case fatality rates for PE during the 1997–2008 in China.MethodsA registration study of patients with suspected PE syndromes admitted to 60 level-3 hospitals involved in the National Cooperative Project for the Prevention and Treatment of Venous Thromboembolism (NCPPT) was conducted from January 1997 to December 2008. The only exclusion criterion was an age of less than 18 years. Helical computed tomography scan, ventilation-perfusion lung scintigraphy or pulmonary angiography was carried out before or after hospitalization. All images were reviewed and evaluated independently by two specialists.ResultsA total of 18,206 patients were confirmed with PE from 16,972,182 hospital admissions. The annual incidence was 0.1% (95% CI: 0.1% to 0.2%). The overall incidence of PE in male patients (0.2%, 95% CI: 0.1% to 0.3%) was higher than that in female patients (0.1% and 95% CI: 0.0% to 0.1%). An increasing incidence gradient for PE was noticed from Southern to Northern China. In addition, the case fatality rate was apparently decreasing: 25.1% (95% CI: 16.2% to 36.9%) in 1997 to 8.7% (95% CI: 3.5% to 15.8%) in 2008.ConclusionsOur findings suggest the relatively stable PE incidence and decreasing fatality trends in Chinese hospitals may be partially attributable to the implementation of the NCCPT and suggest the government should reevaluate the severity of PE so that health resources for the prevention, diagnosis and treatment of PE could be used to their fullest.

show abstract

“…African Americans also have higher age-adjusted rates of cardiac arrest in or out of the hospital (32) (33) (34) , acute lung injury (ALI) (35) , noncardiogenic acute respiratory failure (16) , and VTE (17) (36) (18) . It is unlikely that the different rates of VTE are due to diagnostic or ascertainment bias since nationwide data show no differences in use of ventilation-perfusion lung scans, venous ultrasonography, or contrast venography by race or gender (37) (38) .…”

Section: Health Disparities In the Course Of Acute Critical Illnessesmentioning

confidence: 99%

Healthcare Disparities in Critical Illness

Soto

Martin

Gong

2013

Critical Care Medicine

129

121

View full text Add to dashboard Cite

Objective To summarize the current literature on racial and gender disparities in critical care and the mechanisms underlying these disparities in the course of acute critical illness. Data Sources MEDLINE search on the published literature addressing racial, ethnic, or gender disparities in acute critical illness such as sepsis, acute lung injury, pneumonia, venous thromboembolism, and cardiac arrest. Study Selection Clinical studies that evaluated general critically ill patient populations in the United States as well as specific critical care conditions were reviewed with a focus on studies evaluating factors and contributors to health disparities. Data Extraction Study findings are presented according to their association with the incidence, clinical presentation, management, and outcomes in acute critical illness. Data Synthesis This review presents potential contributors for racial and gender disparities related to genetic susceptibility, comorbidities, preventive health services, socioeconomic factors, cultural differences, and access to care. The data is organized along the course of acute critical illness. Conclusions The literature to date shows that disparities in critical care are most likely multifactorial involving individual, community, and hospital-level factors at several points in the continuum of acute critical illness. The data presented identify potential targets as interventions to reduce disparities in critical care and future avenues for research.

show abstract

Venous Thromboembolic Disease

Abstract: Data from the National Hospital Discharge Survey do not support a sex bias in the diagnosis of PE or DVT, the use of diagnostic tests, or the duration of hospitalization for PE or DVT.

Cited by 39 publications

References 52 publications

Sex differences in guideline‐consistent diagnostic testing for acute pulmonary embolism among adult emergency department patients aged 18–49

Sex differences in guideline‐consistent diagnostic testing for acute pulmonary embolism among adult emergency department patients aged 18–49

Pulmonary Embolism Incidence and Fatality Trends in Chinese Hospitals from 1997 to 2008: A Multicenter Registration Study

Healthcare Disparities in Critical Illness

Contact Info

Product

Resources

About