Document Detail


Spiral computed tomography for the diagnosis of pulmonary embolism in critically ill surgical patients: a comparison with pulmonary angiography.
MedLine Citation:
PMID:  11343539     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
HYPOTHESIS: Spiral computed tomographic pulmonary angiography (CTPA) is sensitive and specific in diagnosing pulmonary embolism (PE) in critically ill surgical patients. DESIGN: Prospective study comparing CTPA with the criterion standard, pulmonary angiography (PA). SETTING: Surgical intensive care unit of an academic hospital. PATIENTS: Twenty-two critically ill surgical patients with clinical suspicion of PE. The CTPAs and PAs were independently read by 4 radiologists (2 for each test) blinded to each other's interpretation. Clinical suspicion was classified as high, intermediate, or low according to predetermined criteria. All but 2 patients had marked pulmonary parenchymal disease at the time of the event that triggered evaluation for PE. INTERVENTIONS: Computed tomographic pulmonary angiography and PA in 22 patients, venous duplex scan in 19. RESULTS: Eleven patients (50%) had evidence of PE on PA, 5 in central and 6 in peripheral pulmonary arteries. The sensitivity and specificity of CTPA was, respectively, 45% and 82% for all PEs, 60% and 100% for central PEs, and 33% and 82% for peripheral PEs. Duplex scanning was 40% sensitive and 100% specific in diagnosing PE. The independent reviewers disagreed only in 14% of CTPA and 14% of PA interpretations. There were no differences in risk factors or clinical characteristics between patients with and without PE. The level of clinical suspicion was identical in the 2 groups. CONCLUSIONS: Pulmonary angiography remains the gold standard for the diagnosis of PE in critically ill surgical patients. Computed tomographic pulmonary angiography needs further evaluation in this population.
Authors:
G C Velmahos; P Vassiliu; A Wilcox; S E Hanks; A Salim; D Harrel; S Palmer; D Demetriades
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  136     ISSN:  0004-0010     ISO Abbreviation:  Arch Surg     Publication Date:  2001 May 
Date Detail:
Created Date:  2001-05-09     Completed Date:  2001-06-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  505-11     Citation Subset:  AIM; IM    
Affiliation:
LAC+USC Medical Center, 1200 N State St, Room 9900, Los Angeles, CA 90033, USA. velmahos@hsc.usc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angiography
Critical Illness
Humans
Middle Aged
Pilot Projects
Prospective Studies
Pulmonary Embolism / radiography*
Sensitivity and Specificity
Tomography, X-Ray Computed* / methods
Comments/Corrections
Comment In:
Curr Surg. 2003 May-Jun;60(3):230-4   [PMID:  15212055 ]

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