Document Detail

Pulmonary embolism incidence is increasing with use of spiral computed tomography.
MedLine Citation:
PMID:  18589057     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Pulmonary embolism causes significant morbidity in hospitalized patients, yet few studies have explored the impact of spiral computed tomography (CT) scanning on diagnosis and clinical outcome.
METHODS: Incidence rates of pulmonary embolism, chest and spiral CT rates, D-dimer assay, anticoagulation, and in-hospital mortality were assessed on statewide pulmonary embolism discharge data (1997-2001) from the Pennsylvania Health Care Cost Containment Council.
RESULTS: The incidence of pulmonary embolism increased from 47 to 63 per 100,000 patients from 1997 to 2001 (mean of 0.004% per year, P < .001). Mean pulmonary embolism incidence rates were higher for African American patients (0.031% per year higher than for white patients), patients aged 70 years or more (0.007% higher than for patients aged<70 years), and female patients (0.013% higher than for male patients) (all P < .001). Concomitantly, the proportion undergoing CT (including spiral) scans increased from 23.23% to 45.18% (odds ratio=1.30; P<.001), controlling for age, gender, race, and cancer, whereas rates for other procedures remained unchanged. By comparing 1999 and before with 2000 and after, there was a significant decrease in the 2 highest Atlas Severity of Illness categories (49.4%-37.7%) and a significant increase in the 3 lowest categories (50.6%-62.3%; P < .001). The risk of in-hospital deaths among patients with pulmonary embolism decreased in this period from 12.8% to 11.1% (P < .001).
CONCLUSION: The incidence of pulmonary embolism is increasing with the increasing use of spiral CT scans, with a lower severity of illness and lower mortality, suggesting the increase is due to earlier diagnosis.
Nicholas A DeMonaco; Qianyu Dang; Wishwa N Kapoor; Margaret V Ragni
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of medicine     Volume:  121     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-30     Completed Date:  2008-07-29     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  611-7     Citation Subset:  AIM; IM    
Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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MeSH Terms
Age Distribution
Continental Population Groups / statistics & numerical data
Fibrin Fibrinogen Degradation Products / analysis
Hospital Mortality
Patient Discharge / statistics & numerical data,  trends
Pennsylvania / epidemiology
Pulmonary Embolism / diagnosis*,  epidemiology*
Risk Factors
Severity of Illness Index
Sex Distribution
Tomography, Spiral Computed / utilization*
Grant Support
Reg. No./Substance:
0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D
Comment In:
Am J Med. 2008 Dec;121(12):e17; author reply e19   [PMID:  19028183 ]

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