Youens David, Doust Jenny, Ha Ninh Thi, O'Leary Peter, Wright Cameron, Parizel Paul M, Moorin Rachael
Health Economics and Data Analytics, School of Population Health, Curtin University, Bentley 6102, Australia.
Australian Women and Girls' Health Research Centre, School of Public Health, University of Queensland, St Lucia 4072, Australia.
J Clin Med. 2023 Jan 27;12(3):980. doi: 10.3390/jcm12030980.
(1) Background: Pulmonary embolism (PE) can be fatal. Computed tomography pulmonary angiography (CTPA) can accurately diagnose PE, but it should be used only when reasonable pre-test probability exists. Overtesting with CTPA exposes patients to excess ionizing radiation and contrast media, while PE overdiagnosis leads to the treatment of small emboli unlikely to cause harm. This study assessed trends in CTPA use and diagnostic yield. We also assessed trends in PE hospitalizations and mortality to indicate PE severity. (2) Methods: Analysis of Western Australian linked administrative data for 2003-2015 including hospitalizations, emergency department (ED) attendances, and CTPA performed at hospitals. Age-sex standardized trends were calculated for CTPA use, PE hospitalizations, and mortality (as a proxy for severity). Logistic regression assessed diagnostic yield of CTPA following unplanned ED presentations. (3) Results: CTPA use increased from 3.3 per 10,000 person-years in 2003 (95% CI 3.0-3.6) to 17.1 per 10,000 person-years (16.5-17.7) in 2015. Diagnostic yield of CTPA increased from 12.7% in 2003 to 17.4% in 2005, declining to 12.2% in 2015 ( = 0.049). PE hospitalizations increased from 3.8 per 10,000 (3.5-4.1) in 2003 to 5.2 per 10,000 (4.8-5.5) in 2015. Mortality remained constant at 0.50 per 10,000 (0.39-0.62) in 2003 and 0.42 per 10,000 (0.32-0.51) in 2015. (4) Conclusions: CTPA increased from 2003 to 2015, while diagnostic yield decreased, potentially indicating overtesting. PE mortality remained constant despite increasing hospitalizations, likely indicating a higher proportion of less severe cases. As treatment can be harmful, this could represent overdiagnosis.
(1) 背景：肺栓塞（PE）可能致命。计算机断层扫描肺动脉造影（CTPA）能够准确诊断PE，但仅应在存在合理的检测前概率时使用。CTPA过度检测会使患者暴露于过量的电离辐射和造影剂中，而PE过度诊断则会导致对不太可能造成伤害的小栓子进行治疗。本研究评估了CTPA使用情况和诊断率的趋势。我们还评估了PE住院率和死亡率的趋势以表明PE的严重程度。(2) 方法：分析2003 - 2015年西澳大利亚州的关联行政数据，包括住院情况、急诊科就诊情况以及医院进行的CTPA检查。计算CTPA使用、PE住院率和死亡率（作为严重程度的替代指标）的年龄 - 性别标准化趋势。逻辑回归评估计划外急诊科就诊后CTPA的诊断率。(3) 结果：CTPA的使用从2003年的每10,000人年3.3次（95%可信区间3.0 - 3.6）增加到2015年的每10,000人年17.1次（16.5 - 17.7）。CTPA的诊断率从2003年的12.7%增加到2005年的17.4%，到2015年降至12.2%（P = 0.049）。PE住院率从2003年的每10,000人3.8次（3.5 - 4.1）增加到2015年的每10,000人5.2次（4.8 - 5.5）。死亡率在2003年保持在每10,000人0.50次（0.39 - 0.62），在2015年为每10,000人0.42次（0.32 - 0.51）。(4) 结论：2003年至2015年CTPA使用增加，而诊断率下降，这可能表明存在过度检测。尽管住院率增加，但PE死亡率保持不变，这可能表明病情较轻的病例比例较高。由于治疗可能有害，这可能代表过度诊断。
