Does the introduction of CTPA affect the incidence, mortality, and treatment complications of pulmonary embolism in United States adults?
The introduction of CTPA was associated with a substantial increase in pulmonary embolism incidence but a smaller reduction in mortality compared to the pre-CTPA era, suggesting potential overdiagnosis.
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, p0.001). Pulmonary embolism mortality decreased during both periods: more so before CTPA (8 % reduction: from 13.4 to 12.3 per 100,000, p0.001) than after (3 % reduction: from 12.3 to 11.9 per 100,000,
Wiener et al. (Sat,) studied this question.
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