Helical CT safely guided the withholding of anticoagulation, as PE occurred in only 5.4% (95% CI 1.3%, 9.7%) of patients with normal CT findings during 3-month follow-up.
Cohort (n=164)
Does helical CT accurately diagnose acute pulmonary embolism and safely guide the withholding of anticoagulation in patients with intermediate probability at V-P scintigraphy and normal leg ultrasound?
Helical CT is an effective tool for diagnosing acute pulmonary embolism and guiding the decision to safely withhold anticoagulation in patients with intermediate V-P scan probability and normal leg ultrasound.
PURPOSE: To assess prospectively the clinical effectiveness of helical computed tomography (CT) in the evaluation of patients with unresolved suspicion for pulmonary embolism (PE). MATERIALS AND METHODS: Helical CT was performed in 164 consecutive patients suspected of having acute PE, intermediate probability at ventilation-perfusion (V-P) scintigraphy, and normal findings at duplex ultrasonography (US) of the legs. Fifteen patients also underwent pulmonary angiography. Helical CT results were analyzed immediately to help plan anticoagulant treatment. If helical CT did not show PE, anticoagulant treatment was not indicated. Clinical outcome for these patients was assessed during 3-month follow-up. RESULTS: In 40 (24.4%) of 164 patients, the diagnosis of PE was based on results at helical CT (n = 39) or pulmonary angiography (n = 1). Repeated Doppler US of the legs depicted one thrombus in the calf of three patients with normal results at helical CT that could have been responsible for PE. During 3-month follow-up, three patients experienced recurrent PE (one death, two recurrences). Therefore, PE occurred in six (5.4% 95% confidence interval, 1.3%, 9.7%) of 112 patients with normal findings at helical CT who did not receive anticoagulant treatment. CONCLUSION: Findings at helical CT allowed accurate diagnosis of acute PE in patients with intermediate probability at V-P scintigraphy and without deep venous thrombosis at duplex sonography of the legs.
Ferretti et al. (Sat,) conducted a cohort in Acute pulmonary embolism (n=164). Helical computed tomography (CT) was evaluated on PE occurrence during 3-month follow-up in patients with normal helical CT who did not receive anticoagulant treatment (95% CI 1.3%, 9.7%). Helical CT safely guided the withholding of anticoagulation, as PE occurred in only 5.4% (95% CI 1.3%, 9.7%) of patients with normal CT findings during 3-month follow-up.