CT Pulmonary Angiography Linked to Overdiagnosis of PE
(HealthDay News) – The increased use of computed tomography (CT) pulmonary angiography is associated with increased incidence of pulmonary embolism among U.S. adults, but with minimal decrease in mortality from pulmonary embolism, according to an analysis published online July 2 in BMJ.
Noting that a missed pulmonary embolism can be fatal, Renda Soylemez Wiener, MD, MPH, from the Boston University School of Medicine, and colleagues discuss the increased use of CT pulmonary angiography and implications for clinical practice.
The researchers found that, in the eight years since the introduction of CT pulmonary angiography in 1998, there has been an 80% increase in the age-adjusted incidence of pulmonary embolism (from 62.1 to 112.3 per 100,000 U.S. adults). However, during the same period there was a small decrease in the age-adjusted mortality from pulmonary embolism, from 12.3 to 11.9 per 100,000, while the age-adjusted case fatality of pulmonary embolism decreased significantly, from 12.1–7.8%. With the increased incidence of pulmonary embolism, there has been a significant increase in presumed anticoagulation complications for patients admitted with pulmonary embolism, from 3.1 to 5.3 per 100,000 from 1998–2006. During the same period, the mean costs associated with admission for pulmonary embolism increased from about $25,000 to $44,000.
"The diagnostic zeal and technological advances meant to improve outcomes of patients with pulmonary embolism are double-edged swords: some patients are helped, but many are harmed through overdiagnosis and overtreatment," the authors write. "To improve outcomes for all patients, we need to learn more about which small emboli need treatment."