Key result
CT pulmonary angiography utilization in the emergency department increased by 227% over 4 years, increasing total PE diagnoses by 89% despite the diagnostic yield dropping from 9.8% to 6.8%.
Why the study?
Does computed tomography pulmonary angiography (CTPA) change the examination volume and diagnostic yield for pulmonary embolism compared to V/Q scintigraphy in emergency department patients?
Observational (n=3,619)
No
Does computed tomography pulmonary angiography (CTPA) change the examination volume and diagnostic yield for pulmonary embolism compared to V/Q scintigraphy in emergency department patients?
Increased availability and lower threshold for CTPA in the emergency department led to higher utilization and more total pulmonary embolism diagnoses, but a lower overall diagnostic yield per scan.
Answers are grounded in this paper and cite their sources.
Greater CTPA use may reflect over-testing with lower yield; leaves open optimal selection criteria for suspected PE.
OBJECTIVE: To compare examination volume and diagnostic yield of computed tomography (CT) pulmonary angiography (CTPA) and ventilation-perfusion (V/Q) scintigraphy for detection of suspected pulmonary embolism (PE) in emergency department patients. METHODS: Every CTPA and V/Q scan result for emergency department patients between October 2001 and September 2005 were reviewed. Patients with prior PE and follow-up examinations were excluded. RESULTS: A total of 3421 CTPA examinations and 198 V/Q scans met inclusion criteria. Average CTPA examinations completed per month increased 227%, from 33.4 to 109.2 for the first and last 24-month periods, respectively. Ventilation-perfusion scintigraphy volume decreased 80% (from 6.9 to 1.4 per month). Total diagnoses of PE per month increased 89% from 4.0 to 7.5, whereas the percentage of positive CTPA examinations dropped from 9.8% to 6.8%. CONCLUSIONS: Availability of CT in the emergency department and lower physician thresholds for test utilization have increased the use of CT pulmonary angiography and increased detection of PE.
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Donohoo et al. (2008) conducted an observational in Suspected pulmonary embolism (n=3,619). Computed tomography pulmonary angiography (CTPA) vs. Ventilation-perfusion (V/Q) scintigraphy was evaluated on Examination volume and diagnostic yield for detection of suspected pulmonary embolism. CT pulmonary angiography utilization in the emergency department increased by 227% over 4 years, increasing total PE diagnoses by 89% despite the diagnostic yield dropping from 9.8% to 6.8%.
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