Finding an alternative diagnosis does not justify increased use of CT-pulmonary angiography
Finding an alternative diagnosis does not justify increased use of CT-pulmonary angiography
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DOI：
10.1186/1471-2466-13-9
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发表时间：
2013-02-07
影响因子：
3.1
通讯作者：
Cohen, Rubin I.
中科院分区：
文献类型：
--
作者：
Chandra, Subani;Sarkar, Pralay K.;Cohen, Rubin I.
背景：CT肺血管造影术(CTPA)的更多使用通常是通过寻找解释患者症状的替代诊断来证明的。方法：我们回顾了我们中心11年来(2000-2010年)对疑似肺血栓(PE)患者所做的CTPA检查。然后，我们详细回顾了具有代表性的三个指标年-2000、2005和2008年的患者样本的医疗记录。我们确定CTPA是否显示了肺栓塞以外的肺部病变，这些病变不能从患者的病史、体格检查和先前的胸部X光中很容易地识别出来。结果：从2000年到2010年，本中心共进行了12,640例CTPA检查。执行CTPA的次数从2000年的84次增加到2010年的2287次，增长了27倍。只有7.6%的CTPA和3.2%的可避免的CTPA(低或中试前概率和D-二聚体阴性)显示了以前未知的任何临床意义的表现。当我们将2008年与2000年和2005年进行比较时，更多的CTPA是在更年轻的患者中进行的(2000年的平均年龄：67岁，2005年：63岁，2008年：60岁，(p=0.004，单因素方差分析))。患者病情较轻，发生PE的风险因素较少。试验前概率的评估和D-二聚体的测量很少被用来选择合适的患者进行CTPA(2000年PE的试验前概率记录在图表中(总百分比)：4.1%，2005年：1.6%，2008年：3.1%)。结论：我们的数据不支持通过寻找能够解释患者症状的替代肺部病理来增加CTPA使用的论点。CTPA正越来越多地被用作可疑PE的第一种也是唯一一种检测方法。
Background: The increased use of computed tomography pulmonary angiography (CTPA) is often justified by finding alternative diagnoses explaining patients' symptoms. However, this has not been rigorously examined.Methods: We retrospectively reviewed CTPA done at our center over an eleven year period (2000 - 2010) in patients with suspected pulmonary embolus (PE). We then reviewed in detail the medical records of a representative sample of patients in three index years - 2000, 2005 and 2008. We determined whether CTPA revealed pulmonary pathology other than PE that was not readily identifiable from the patient's history, physical examination and prior chest X-ray. We also assessed whether the use of pre-test probability guided diagnostic strategy for PE.Results: A total of 12,640 CTPA were performed at our center from year 2000 to 2010. The number of CTPA performed increased from 84 in 2000 to 2287 in 2010, a 27 fold increase. Only 7.6 percent of all CTPA and 3.2 percent of avoidable CTPAs (low or intermediate pre-test probability and negative D-dimer) revealed previously unknown findings of any clinical significance. When we compared 2008 to 2000 and 2005, more CTPAs were performed in younger patients (mean age (years) for 2000: 67, 2005: 63, and 2008: 60, (p=0.004, one-way ANOVA)). Patients were less acutely ill with fewer risk factors for PE. Assessment of pre-test probability of PE and D-dimer measurement were rarely used to select appropriate patients for CTPA (pre-test probability of PE documented in chart (%total) in year 2000: 4.1%, 2005: 1.6%, 2008: 3.1%).Conclusions: Our data do not support the argument that increased CTPA use is justified by finding an alternative pulmonary pathology that could explain patients' symptoms. CTPA is being increasingly used as the first and only test for suspected PE.