Division of Pulmonary, Critical Care and Sleep Medicine, The Long Island Jewish Medical Center, The Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York, NY 11040, USA.
BMC Pulm Med. 2013 Feb 7;13:9. doi: 10.1186/1471-2466-13-9.
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.
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.
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%).
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.
计算机断层肺动脉造影（CTPA）的应用日益增多，通常可以通过发现其他可解释患者症状的诊断来证明其合理性。然而，这一点尚未得到严格的检验。
我们对在我们中心进行的为期十一年的疑似肺栓塞（PE）患者 CTPA 进行了回顾性研究（2000-2010 年）。然后，我们详细审查了 2000 年、2005 年和 2008 年三个索引年内具有代表性的患者的病历。我们确定 CTPA 是否揭示了除 PE 以外的其他肺部病理，而这些病理在患者的病史、体检和先前的胸部 X 光片中无法轻易识别。我们还评估了是否使用了 PE 的预测概率指导诊断策略。
2000 年至 2010 年，我们中心共进行了 12640 次 CTPA。CTPA 的数量从 2000 年的 84 次增加到 2010 年的 2287 次，增加了 27 倍。只有 7.6%的 CTPA 和 3.2%的可避免 CTPA（低或中等预测概率和阴性 D-二聚体）揭示了任何具有临床意义的先前未知发现。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（岁）：67，2005 年：63，2008 年：60，（p=0.004，单向方差分析））。患者的病情不那么危急，PE 的风险因素也较少。PE 的预测概率评估和 D-二聚体测量很少用于选择合适的 CTPA 患者（2000 年：4.1%，2005 年：1.6%，2008 年：3.1%）。
我们的数据不支持 CTPA 使用率增加是因为发现了可解释患者症状的其他肺部病理这一观点。CTPA 作为疑似 PE 的首选和唯一检查手段，应用日益广泛。
