Document Detail


Changing trends in venous thromboembolism-related imaging in Western Australian teaching hospitals, 2002-2010.
MedLine Citation:
PMID:  23373501     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine trends in referral for venous thromboembolism (VTE) imaging in Western Australian teaching hospitals.
DESIGN AND SETTING: Retrospective audit of the WA picture archiving and communication system, PathWest Laboratory Medicine records, the hospital morbidity database at the four adult teaching hospitals in Perth, WA, and the WA death registry.
PATIENTS: All patients referred for VTE-related imaging, and all hospital separations for pulmonary embolism (PE) during 2002-2010.
MAIN OUTCOME MEASURES: Number of referrals for computed tomography pulmonary angiography (CTPA), ventilation-perfusion lung scintigraphy, leg ultrasound and plasma D-dimer assay; hospital separations for PE and deaths from PE.
RESULTS: Referrals for VTE-related imaging increased by 34%, while PE-related imaging increased by 65% during the study period, owing entirely to referrals for CTPA, which increased by more than 500%. The number of hospital separations for PE increased by 45% over the same period and the prevalence of PE among referred patients fell from 22.1% in 2002 to 19.5% in 2010. There was no fall in the death rate from PE in WA during the study period (P = 0.19). The number of D-dimer tests performed in the same hospitals increased by 42% over the study period.
CONCLUSIONS: The increased number of referrals for PE-related imaging resulted in more diagnoses but no reduction in deaths from PE in WA. Widespread D-dimer testing did not reduce referrals for imaging and is likely to have resulted in increased referrals. Increased imaging leads to overdiagnosis of clinically insignificant PE, and alternative strategies are required to reduce PE death rates.
Authors:
Tatiana Segard; William B G Macdonald
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Medical journal of Australia     Volume:  198     ISSN:  1326-5377     ISO Abbreviation:  Med. J. Aust.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-04     Completed Date:  2013-04-05     Revised Date:  2014-03-12    
Medline Journal Info:
Nlm Unique ID:  0400714     Medline TA:  Med J Aust     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  100-3     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Fibrin Fibrinogen Degradation Products / analysis
Hospitals, Teaching / statistics & numerical data,  trends*
Humans
Linear Models
Lung / blood supply,  radiography
Prevalence
Pulmonary Embolism / diagnosis,  epidemiology,  mortality,  radiography
Referral and Consultation / statistics & numerical data,  trends
Retrospective Studies
Tomography, X-Ray Computed / utilization
Venous Thromboembolism / diagnosis,  epidemiology,  mortality,  radiography*
Western Australia / epidemiology
Chemical
Reg. No./Substance:
0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D
Comments/Corrections
Comment In:
Med J Aust. 2014 Jan 20;200(1):27   [PMID:  24438414 ]
Med J Aust. 2014 Jan 20;200(1):26-7   [PMID:  24438413 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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