RESPECT-ED: Rates of Pulmonary Emboli PE and Sub-Segmental PE with Modern Computed Tomographic Pulmonary Angiograms in Emergency Departments: A Multi-Center Observational Study Finds Significant Yield Variation, Uncorrelated with Reportar como inadecuado




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Introduction

Overuse of CT Pulmonary Angiograms CTPA for diagnosing pulmonary embolism PE, particularly in Emergency Departments ED, is considered problematic. Marked variations in positive CTPA rates are reported, with American 4–10% yields driving most concerns. Higher resolution CTPA may increase sub-segmental PE SSPE diagnoses, which may be up to 40% false positive. Excessive use and false positives could increase harm vs. benefit. These issues have not been systematically examined outside America.

Aims

To describe current yield variation and CTPA utilisation in Australasian ED, exploring potential factors correlated with variation.

Methods

A retrospective multi-centre review of consecutive ED-ordered CTPA using standard radiology reports. ED CTPA report data were inputted onto preformatted data-sheets. The primary outcome was site level yield, analysed both intra-site and against a nominated 15.3% yield. Factors potentially associated with yield were assessed for correlation.

Results

Fourteen radiology departments 15 ED provided 7077 CTPA data 94% ≥64-slice CT; PE were reported in 1028 yield 14.6% 95%CI 13.8–15.4%; range 9.3–25.3%; site variation p <0.0001 with four sites significantly below and one above the 15.3% target. Admissions, CTPA usage, PE diagnosis rates and size of PE were uncorrelated with yield. Large PE ≥lobar were 55% CI: 52.1–58.2% and SSPE 8.8% CI: 7.1–10.5% of positive scans. CTPA usage 0.2–1.5% adult attendances was correlated p<0.006 with PE diagnosis but not SSPE: large PE proportions.

Discussion- Conclusions

We found significant intra-site CTPA yield variation within Australasia. Yield was not clearly correlated with CTPA usage or increased small PE rates. Both SSPE and large PE rates were similar to higher yield historical cohorts. CTPA use was considerably below USA 2.5–3% rates. Higher CTPA utilisation was positively correlated with PE diagnoses, but without evidence of increased proportions of small PE. This suggests that increased diagnoses seem to be of clinically relevant sized PE.



Autor: David Mountain , Gerben Keijzers , Kevin Chu , Anthony Joseph , Catherine Read , Gabriel Blecher, Jeremy Furyk, Chrianna Bharat ,

Fuente: http://plos.srce.hr/



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