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. 2013 Jun 12;8(6):e65669.
doi: 10.1371/journal.pone.0065669. Print 2013.

CT pulmonary angiography: increasingly diagnosing less severe pulmonary emboli

Andrew J Schissler  1 , Anna Rozenshtein, Michal E Kulon, Gregory D N Pearson, Robert A Green, Peter D Stetson, David J Brenner, Belinda D'Souza, Wei-Yann Tsai, Neil W Schluger, Andrew J Einstein
Affiliations

CT pulmonary angiography: increasingly diagnosing less severe pulmonary emboli

Andrew J Schissler et al. PLoS One. .

Abstract

Background: It is unknown whether the observed increase in computed tomography pulmonary angiography (CTPA) utilization has resulted in increased detection of pulmonary emboli (PEs) with a less severe disease spectrum.

Methods: Trends in utilization, diagnostic yield, and disease severity were evaluated for 4,048 consecutive initial CTPAs performed in adult patients in the emergency department of a large urban academic medical center between 1/1/2004 and 10/31/2009. Transthoracic echocardiography (TTE) findings and peak serum troponin levels were evaluated to assess for the presence of PE-associated right ventricular (RV) abnormalities (dysfunction or dilatation) and myocardial injury, respectively. Statistical analyses were performed using multivariate logistic regression.

Results: 268 CTPAs (6.6%) were positive for acute PE, and 3,780 (93.4%) demonstrated either no PE or chronic PE. There was a significant increase in the likelihood of undergoing CTPA per year during the study period (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.04-1.07, P<0.01). There was no significant change in the likelihood of having a CTPA diagnostic of an acute PE per year (OR 1.03, 95% CI 0.95-1.11, P = 0.49). The likelihood of diagnosing a less severe PE on CTPA with no associated RV abnormalities or myocardial injury increased per year during the study period (OR 1.39, 95% CI 1.10-1.75, P = 0.01).

Conclusions: CTPA utilization has risen with no corresponding change in diagnostic yield, resulting in an increase in PE detection. There is a concurrent rise in the likelihood of diagnosing a less clinically severe spectrum of PEs.

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Conflict of interest statement

Competing Interests: The authors have read the journal's policy and have the following conflicts: Dr. Einstein receives research grants from GE Healthcare and Philips Medical Systems for unrelated research. Dr. Schissler, Dr. Rozenshtein, Dr. Kulon, Dr. Pearson, Dr. Green, Dr. Stetson, Dr. Brenner, Dr. D'Souza, Dr. Tsai, and Dr. Schluger do not have any conflicts of interest, either personal or financial. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Annual CTPA utilization patterns.
Graph shows an increase in the number of CTPAs ordered from 2004 to 2009 with concurrent increase in number of scans positive for an acute PE.
Figure 2
Figure 2. Annual number of PEs diagnosed by CTPA, number of PEs without associated RV abnormalities or myocardial injury, and number of PEs with associated RV dysfunction and/or dilatation and/or myocardial injury.
See this image and copyright information in PMC

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