SESSION TITLE: DVT/PE Posters
SESSION TYPE: Poster Presentations
PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM
PURPOSE: Computed tomography with contrast of the pulmonary arteries (CTPA) is the most commonly used test to evaluate and diagnose pulmonary embolism (PE) in the Emergency Department (ED) setting. Contrast induced nephropathy (CIN) is a concerning sequela of contrast based studies. The aim of this study was to assess the frequency of CIN in patients undergoing CTPA in the ED setting.
METHODS: We conducted a retrospective chart review of all patients who underwent CTPA for evaluation of PE in a single center, tertiary care ED from Jan 1 - Dec 31 2010. Serum creatinine (sCr) values both pre and post-CTPA were reviewed. Our primary endpoint was the development of CIN, defined as an absolute increase in sCr of ≥0.5 mg/dL or relative increase of ≥25% compared to baseline sCr within 48 hours of contrast exposure. Patients with end stage renal disease were excluded. As a secondary endpoint, we looked at whether specific comorbidities were associated with an increased incidence of CIN.
RESULTS: A total of 1677 patients (mean age 57.2 +/- 16.5 years, 64.4% female) underwent CTPA over the year-long study period. Overall PE was diagnosed in 6.5% (95% CI: 5.3% - 7.7%). Post-CTPA sCr values were obtained in 601 patients, and 11.5% of patients with paired sCr developed CIN (95% CI: 8.9% - 14.0%). When looking at other comorbidities, CHF was the only comorbidity associated with an increased incidence of CIN (odds ratio 3.58, 95% CI 1.77 - 7.24, p <0.0001).
CONCLUSIONS: The incidence of CIN was high in our study despite a low overall diagnostic yield of CTPA for PE. Additionally, patients with CHF may be at increased risk of developing CIN after CTPA.
CLINICAL IMPLICATIONS: The high rate of CIN suggests that providers need to carefully weigh the risks of CTPA prior to obtaining this test. Adjunctive testing and/or use of scoring systems may better define a population where the potential benefit of CTPA outweighs the risks.
DISCLOSURE: The following authors have nothing to disclose: Omar Aly, Erik Vakil, Mohammad Kousha, Genese Lamare, A. Shorr, Chee Chan
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