Pulmonary Embolism Incidence Is Increasing with Use of Spiral Computed Tomography - 20/08/11
Requests for reprints should be addressed to Margaret V. Ragni, MD, MPH, Professor of Medicine, Department of Medicine, Division Hematology/Oncology, University of Pittsburgh School of Medicine, Hemophilia Center of Western Pennsylvania, 3636 Boulevard of the Allies, Pittsburgh, PA 15213-4306.Abstract |
Background |
Pulmonary embolism causes significant morbidity in hospitalized patients, yet few studies have explored the impact of spiral computed tomography (CT) scanning on diagnosis and clinical outcome.
Methods |
Incidence rates of pulmonary embolism, chest and spiral CT rates, D-dimer assay, anticoagulation, and in-hospital mortality were assessed on statewide pulmonary embolism discharge data (1997-2001) from the Pennsylvania Health Care Cost Containment Council.
Results |
The incidence of pulmonary embolism increased from 47 to 63 per 100,000 patients from 1997 to 2001 (mean of 0.004% per year, P < .001). Mean pulmonary embolism incidence rates were higher for African American patients (0.031% per year higher than for white patients), patients aged 70 years or more (0.007% higher than for patients aged<70 years), and female patients (0.013% higher than for male patients) (all P < .001). Concomitantly, the proportion undergoing CT (including spiral) scans increased from 23.23% to 45.18% (odds ratio=1.30; P<.001), controlling for age, gender, race, and cancer, whereas rates for other procedures remained unchanged. By comparing 1999 and before with 2000 and after, there was a significant decrease in the 2 highest Atlas Severity of Illness categories (49.4%-37.7%) and a significant increase in the 3 lowest categories (50.6%-62.3%; P < .001). The risk of in-hospital deaths among patients with pulmonary embolism decreased in this period from 12.8% to 11.1% (P < .001).
Conclusion |
The incidence of pulmonary embolism is increasing with the increasing use of spiral CT scans, with a lower severity of illness and lower mortality, suggesting the increase is due to earlier diagnosis.
El texto completo de este artículo está disponible en PDF.Keywords : Hospital discharges, Pulmonary embolism, Spiral computed tomography, Venous thromboembolism
Esquema
| This work was sponsored by a grant from the Jewish Healthcare Foundation, Pittsburgh, Pennsylvania. The sponsor had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the article. |
Vol 121 - N° 7
P. 611-617 - juillet 2008 Regresar al número
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