Maimonides Medical Center, Brooklyn, NY
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Pulmonary Vascular Disease: VTE
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM
PURPOSE: Despite the disseminated knowledge of well validated protocols including PERC criteria, Well's criteria, Geneva score and the use of d-dimers, CTPA is often inappropriately utilized. We performed this study to evaluate the yield of CTPA for the diagnosis of pulmonary disease for patients presenting with dyspnea.
METHODS: All medical records of patients with CTPA ordered from the Emergency Department from 2010 to 2015 at our hospital were retrospectively reviewed. A total number of 936 patient charts were reviewed. The number of patients with diagnosed pulmonary embolism, as well as alternative diagnoses like pulmonary edema, pneumonia, emphysema, malignancy and interstitial lung disease (ILD) as a cause for dyspnea were determined.
RESULTS: A total number of 936 patient charts were reviewed. 368 patients (39%) had no significant findings on CTPA. A total of 88 patients (9.4%) were diagnosed with a pulmonary embolus. Alternative diagnoses were found in 480 patients (51%) including 77 patients (8.2%) with pneumonia, 82 (8.8%) patients with pulmonary edema, 12 patients (1%) with ILD, 34 patients (3.6%) with emphysema and 232 patients (24.8%) had incidental findings including 49 patients (5.2%) with lung nodules.
CONCLUSIONS: In patients evaluated for pulmonary embolism at this community hospital, only about 10% patients were diagnosed with pulmonary embolism. An alternative diagnosis was found in about half the number of patients, with the most commonly diagnosed conditions being pneumonia, pulmonary edema and pulmonary nodules. This study shows the possible overuse of CTPA for diagnosing pulmonary embolism, but reveals alternative diagnosis in about half the patients that may be useful for the treating physician.
CLINICAL IMPLICATIONS: This study suggests that CTPA may be over-utilized for diagnosing pulmonary embolism. A high number of alternative diagnoses were provided to the physician with a CTPA. It is unclear whether these alternate diagnoses impacted the clinical outcome, hospital stay or if the benefits outweighed the risks of radiation and contrast. This will need to be further evaluated in larger prospective studies.
DISCLOSURE: The following authors have nothing to disclose: Shyam Shankar, Animesh Gour, Suchit Khanijao, Omar Taha, Karishma Kitchloo, Pavan Gorukanti, Guy Kulbak, Chanaka Seneviratne, Yizhak Kupfer
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