Overdiagnosis of pulmonary embolism associated with computed tomography

January 01, 0001

Overdiagnosis of pulmonary embolism associated with computed tomography

Computed tomographic pulmonary angiography (CTPA) may improve detection of life-threatening pulmonary embolism (PE), but this sensitive test may have a downside: overdiagnosis and overtreatment by finding clinically unimportant emboli and exposing patients to harms from unnecessary treatment. These US authors assessed the impact of CTPA on national PE incidence, mortality, and treatment complications using the Nationwide Inpatient Sample and Multiple Cause-of-Death databases in an age-adjusted analysis before and after introduction of CTPA, 1993-1998 vs. 1998-2006.

They found: "Pulmonary embolism incidence was unchanged before CTPA but increased substantially after CTPA (81% increase, from 62.1 to 112.3 per 100,000). Pulmonary embolism mortality decreased during both periods: more so before CTPA (8% reduction, from 13.4 to 12.3 per 100,000;) than after (3% reduction, from 12.3 to 11.9 per 100,000). Case fatality improved slightly before (8% decrease, from 13.2% to 12.1) and substantially after CTPA (36% decrease, from 12.1% to 7.8%). Meanwhile, CTPA was associated with an increase in presumed complications of anticoagulation for PE: before CTPA, the complication rate was stable, but after it increased by 71% (from 3.1 to 5.3 per 100,000)."

The authors concluded: "The introduction of CTPA was associated with changes consistent with overdiagnosis: rising incidence, minimal change in mortality, and lower case fatality. Better technology allows us to diagnose more emboli, but to minimize harms of overdiagnosis we must learn which ones matter."

This report should lead to a whole series of additional studies to define which pulmonary emboli are clinically important.

For the full abstract, click here.

Arch Intern Med 171(9):831-837, 9 May 2011 © 2011 to the American Medical Association
Time Trends in Pulmonary Embolism in the United States- Evidence of Overdiagnosis. Renda Soylemez Wiener, Lisa M. Schwartz, Steven Woloshin.

Category: R. Respiratory, K. Circulatory. Keywords: pulmonary embolism, computed tomography pulmonary angiography, mortality, overdiagnosis, before and after study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 5 Aug 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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