The introduction of spiral CT angiography increased the diagnostic rate of pulmonary embolism from 1.8 to 2.8 per 1,000 hospital admissions (p < 0.0001).
Observational
No
Does the introduction of spiral CT angiography increase the diagnostic rate of pulmonary embolism in a community hospital setting?
The introduction of spiral CT angiography in a community hospital significantly increased the diagnostic rate of pulmonary embolism and provided additional useful diagnostic information without substantially increasing costs per diagnosis.
Absolute Event Rate: 2.8% vs 1.8%
p-value: p=< 0.0001
BACKGROUND: While the optimal role of spiral CT angiography (CTA) in the diagnosis of pulmonary embolism (PE) remains controversial, this technology is already being widely utilized in the community setting. OBJECTIVES: To assess the impact CTA has had on angiography utilization rates and the overall diagnostic rate of PE. METHODS: All patients evaluated for PE during a 4-year period were studied. PE was defined as either a high-probability V/Q scan, a positive conventional angiogram, or a CTA with emboli in the segmental or larger pulmonary vessels. Diagnostic rates of PE per 1,000 hospital admissions were determined and analyzed for time periods before and after the introduction of CTA. CT reports were compared with their concurrent chest radiograph (CXR) reports and additional findings that were not apparent on CXR were abstracted. RESULTS: The diagnostic rate of PE per 1,000 hospital admissions was 1.8 prior to the introduction of CTA and increased to 2.8 per 1,000 admissions after the introduction of CTA (p < 0.0001). Total costs for diagnostic testing per PE diagnosis made went from US 2,518 dollars to US 2,572 dollars. While the number of PE diagnosed by V/Q scan remained constant, the number of PE diagnosed by conventional angiography decreased while the number diagnosed by CTA increased. In patients with intermediate probability V/Q scan results, the percentage of patients receiving subsequent angiography (conventional or CTA) increased from 17 to 26% (p = 0.043). When conventional angiography was performed, CT imaging of the chest still had to be ordered for other reasons 38% of the time. Additional information was obtained in 78% of cases when CTA was performed. CONCLUSIONS: Increased utilization of CTA was associated with an increase in angiography utilization rates and diagnostic rates of PE, was cost effective, and often provided additional, useful, and unanticipated diagnostic information.
Ost et al. (Thu,) conducted a observational in Pulmonary embolism. Spiral computed tomography angiography (CTA) vs. Time period prior to the introduction of CTA was evaluated on Diagnostic rate of PE per 1,000 hospital admissions (p=< 0.0001). The introduction of spiral CT angiography increased the diagnostic rate of pulmonary embolism from 1.8 to 2.8 per 1,000 hospital admissions (p < 0.0001).