Yield of CT pulmonary angiography in the diagnosis of acute pulmonary embolism: short report

Chen, Zhongyi; Deblois, Simon; Toporowicz, Kevin; Boldeanu, Irina; Francoeur, Marie-Odile; Sadouni, Manel; Lepanto, Luigi; Chartrand-Lefèbvre, Carl

doi:10.1186/s13104-019-4076-8

Cited by 22 publications

(18 citation statements)

References 15 publications

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“…This compares to the yield of CTPA of inpatients, prior to the COVID-19 epidemic, of 12 to 17% [24][25][26], and 18% in an ICU environment [25]. Most literature on the use of CTPA centres on over-utilisation, particularly if yields fall below 10% [24][25][26]. The high-yield from CTPA in our series raises the possibility of relative under-diagnosis of PE in patients with COVID-19.…”

Section: Discussionmentioning

confidence: 54%

“…This study of hospitalised patients showed that in patients with suspected or confirmed COVID-19, and clinical suspicion for PE, more than one-third of CTPA studies were positive for PE. This compares to the yield of CTPA of inpatients, prior to the COVID-19 epidemic, of 12 to 17% [24][25][26], and 18% in an ICU environment [25]. Most literature on the use of CTPA centres on over-utilisation, particularly if yields fall below 10% [24][25][26].…”

Section: Discussionmentioning

confidence: 95%

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Pulmonary embolism in hospitalised patients with COVID-19

Whyte

Kelly

Gonzalez

et al. 2020

Thrombosis Research

129

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Background: Coronavirus disease 2019 (COVID-19) is characterised by dyspnoea and abnormal coagulation parameters, including raised D-dimer. Data suggests a high incidence of pulmonary embolism (PE) in ventilated patients with COVID-19. Objectives: To determine the incidence of PE in hospitalised patients with COVID-19 and the diagnostic yield of Computer Tomography Pulmonary Angiography (CTPA) for PE. We also examined the utility of D-dimer and conventional pre-test probability for diagnosis of PE in COVID-19. Patients/methods: Retrospective review of single-centre data of all CTPA studies in patients with suspected or confirmed COVID-19 identified from Electronic Patient Records (EPR). Results: There were 1477 patients admitted with COVID-19 and 214 CTPA scans performed, of which n = 180 (84%) were requested outside of critical care. The diagnostic yield for PE was 37%. The overall proportion of PE in patients with COVID-19 was 5.4%. The proportions with Wells score of ≥4 ('PE likely') was 33/134 (25%) without PE vs 20/80 (25%) with PE (P = 0.951). The median National Early Warning-2 (NEWS2) score (illness severity) was 5 (interquartile range [IQR] 3-9) in PE group vs 4 (IQR 2-7) in those without PE (P = 0.133). Ddimer was higher in PE (median 8000 ng/mL; IQR 4665-8000 ng/mL) than non-PE (2060 ng/mL, IQR 1210-4410 ng/mL, P < 0.001). In the 'low probability' group, D-dimer was higher (P < 0.001) in those with PE but had a limited role in excluding PE. Conclusions: Even outside of the critical care environment, PE in hospitalised patients with COVID-19 is common. Of note, approaching half of PE events were diagnosed on hospital admission. More data are needed to identify an optimal diagnostic pathway in patients with COVID-19. Randomised controlled trials of intensified thromboprophylaxis are urgently needed.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 95%

Pulmonary embolism in hospitalised patients with COVID-19

Whyte

Kelly

Gonzalez

et al. 2020

Thrombosis Research

129

View full text Add to dashboard Cite

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“…In some cases these units even produced primary data and collaborated with researchers to cope with the lack of evidence in the scientific literature. [32][33][34][35] Many respondents supported that CSRs contained not enough data to support the decisional process and clinical practice. As a future avenue, it would be interesting to see if the opinion of the HTA units about the use of the CSRs has changed over the last 6 years.…”

Section: Resultsmentioning

confidence: 99%

Experiences of Using Cochrane Systematic Reviews by Local HTA Units

Poder

Rhainds

Bellemare

et al. 2020

Int J Health Policy Manag

Self Cite

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This study evaluated the use of Cochrane systematic reviews (CSRs) by Quebec’s local health technology assessment (HTA) units to promote efficiency in hospital decision-making. An online survey was conducted to examine: Characteristics of the HTA units; Knowledge about works and services from the Cochrane Collaboration; Level of satisfaction about the use of CSRs; Facilitating factors and barriers to the implementation of CSRs evidence in a local context; Suggestions to improve the use of CSRs. Data accuracy was checked by 2 independent evaluators. Ten HTA units participated. From their implementation a total of 321 HTA reports were published (49.8% included a SR). Works and services provided by the Cochrane collaboration were very well-known and HTA units were highly satisfied with CSRs (80%-100%). As regards to applicability in HTA and use of CSRs, major strengths were as follow: Useful as resource for search terms and background material; May reduce the workload (eg, brief review instead of full SR); Use to update a current review. Major weaknesses were: Limited use since no CSRs were available for many HTA projects; Difficulty to apply findings to local context; Focused only on efficacy and innocuity; Cannot be used as a substitute to a full HTA report. This study provided a unique context of assessment with a familiar group of producers, users and disseminators of CSRs in hospital setting. Since they generally used other articles from the literature or produce an original SR in complement with CSRs, this led to suggestions to improve their use of CSRs. However, the main limit for the use of CRS in local HTA will remain its lack of contextualisation. As such, this study reinforces the need to consider the notion of complementarity of experimental data informing us about causality and contextual data, allowing decision-making adapted to local issues.

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“…Similarly, in a more recent prospective trial [ 4 ] that included 1814 patients from 12 hospitals, the diagnostic yield of CTPA for PE was shown to be 25%. In another retrospective study [ 5 ] done in a Canadian academic tertiary care center, a 15.9% positive rate for PE detection via CTPA was reported. In contrast to these previous studies, our study demonstrated a higher diagnostic yield of CTPA for PE.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic yield of CT pulmonary angiography for pulmonary embolism in clinically suspected patients

Alshumrani¹,

Bshabshe

Mousa³

2021

Medicine

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Pulmonary embolism (PE) is a common medical problem. Its diagnostic criteria must be reviewed to determine the need for confirmatory testing. Computed tomography pulmonary angiography (CTPA) is the current standard of care, which provides accurate diagnosis with rapid turnaround. This study aimed to estimate the diagnostic yield of CTPA in clinically suspected PE patients in a tertiary care hospital in Saudi Arabia. Radiology records of all patients with clinically suspected PE who underwent CTPA between January 1, 2012 and September 30, 2018 were reviewed retrospectively. A radiologist with 10 years of professional experience interpreted and reported all cases. The Wells score with 2 tiers (likely and unlikely) was used to raise the clinical suspicion of PE. Positive results for PE were reported in 177 out of 534 clinically suspected cases (33%). Among the positive PE cases, 143 were acute (81%) and 34 (19%) were chronic. Bilateral, right-sided, and left-sided PE were found in 115 (65%), 37 (21%), and 25 (14%) cases, respectively. Involvement of the segmental branches, subsegmental branches, and the pulmonary trunk were noted in 152 (86%), 70 (40%), and 9 cases (5%), respectively. Saddle PE was found in (4%) of the cases. The lower lobe branches (right 55%, left 53%) and the upper lobe branches (right 47%, left 41%) were the most common sites of involvement. CTPA had a higher positive detection rate for PE among clinically suspected cases than its published diagnostic yield. Adequate clinical evaluation when selecting patients for CTPA is emphasized to minimize unjustified exposure of the patients to radiation and intravenous contrast administration. It is crucial for radiologists to provide detailed reports commenting on all relevant findings, including pertinent negatives. A template for reporting radiological findings for CTPA can be recommended for this purpose.

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Yield of CT pulmonary angiography in the diagnosis of acute pulmonary embolism: short report

Cited by 22 publications

References 15 publications

Pulmonary embolism in hospitalised patients with COVID-19

Pulmonary embolism in hospitalised patients with COVID-19

Experiences of Using Cochrane Systematic Reviews by Local HTA Units

Diagnostic yield of CT pulmonary angiography for pulmonary embolism in clinically suspected patients

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