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Abstract: Poster Presentations |

A Community Hospital Analysis of Computed Tomography Pulmonary Angiogram in the Diagnosis of Pulmonary Embolism FREE TO VIEW

Adrian S. Bucerzan, MD; Dragos Zanchi, MD; Maydee Rosario, MD; William Dinan, MD, FCCP; Ari Klapholz, MD, FCCP
Author and Funding Information

Cabrini Medical Center, New York, NY


Chest


Chest. 2003;124(4_MeetingAbstracts):237S. doi:10.1378/chest.124.4_MeetingAbstracts.237S-b
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Abstract

PURPOSE:  To assess the outcome and value of computed tomography pulmonary angiogram(CTPA) as the initial diagnostic test for pulmonary embolism(PE). Previously, we had evaluated the diagnostic value of ventilation/perfusion scan(V/Q) in our institution.

METHODS:  Retrospective review of inpatient records from 01/2001 to 12/2001.

RESULTS:  92 patients had CTPA for suspected PE. They were divided in 3 groups according to their pretest clinical probability(CP) of PE. Of the 62 patients(67.4%) with low CP, 3(4.8%) had a positive CTPA and were anticoagulated. Of the 22 patients(23.9%) with intermediate CP, 4(18.2%) had a positive CTPA and were anticoagulated. Of the 8 patients(8.7%) with high CP, 4(50%) had positive CTPA and were anticoagulated. 18 patients (8 with low CP, 8 with intermediate CP, and 2 with high CP) out of the 81 with negative CTPA had additional testing for venous thromboembolism(VTE). Only 1 (from the high CP group) of these 18 patients had a positive test for VTE (a high probability V/Q) and was anticoagulated. Of all the negative CTPA, 17 of them provided significant, additional diagnostic information that was not evident on the chest radiograph.CONCLUSIONS: The yield for a positive CTPA in our intermediate/high CP group was 27% (8 out of 30 patients). In the same CP group in the PIOPED study, the yield of a high probability V/Q was 17%. Unlike the V/Q, CTPA offers additional diagnostic information of diseases of the chest. Because of the very low yield of a positive CTPA in patients with low CP (5%), medical centers should set up specific pathways and screening processes to limit wasteful testing.

CLINICAL IMPLICATIONS:  CTPA is emerging as the primary diagnostic test for PE. Evaluating patient‘s CP for PE remains an important first step before deciding on the appropriateness of a diagnostic work-up for PE.

DISCLOSURE:  A.S. Bucerzan, None.

Wednesday, October 29, 2003

12:30 PM - 2:00 PM


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