Document Detail


Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta-analysis of the management outcome studies.
MedLine Citation:
PMID:  20546118     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Multiple-detectors computed tomographic pulmonary angiography (CTPA) has a higher sensitivity for pulmonary embolism (PE) within the subsegmental pulmonary arteries as compared with single-detector CTPA. Multiple-detectors CTPA might increase the rate of subsegmental PE diagnosis. The clinical significance of subsegmental PE is unknown. We sought to summarize the proportion of subsegmental PE diagnosed with single- and multiple-detectors CTPA and assess the safety of diagnostic strategies based on single- or multiple-detectors CTPA to exclude PE.
PATIENTS AND METHODS: A systematic literature search strategy was conducted using MEDLINE, EMBASE and the Cochrane Register of Controlled Trials. We selected 22 articles (20 prospective cohort studies and two randomized controlled trials) that included patients with suspected PE who underwent a CTPA and reported the rate of subsegmental PE. Two reviewers independently extracted data onto standardized forms.
RESULTS: The rate of subsegmental PE diagnosis was 4.7% [95% confidence interval (CI): 2.5-7.6] and 9.4 (95% CI: 5.5-14.2) in patients that underwent a single- and multiple-detectors CTPA, respectively. The 3-month thromboembolic risks in patients with suspected PE and who were left untreated based on a diagnostic algorithm including a negative CTPA was 0.9% (95% CI: 0.4-1.4) and 1.1% (95% CI: 0.7-1.4) for single- and multiple-detectors CTPA, respectively.
CONCLUSION: Multiple-detectors CTPA seems to increase the proportion of patients diagnosed with subsegmental PE without lowering the 3-month risk of thromboembolism suggesting that subsegmental PE may not be clinically relevant.
Authors:
M Carrier; M Righini; P S Wells; A Perrier; D R Anderson; M A Rodger; S Pleasance; G Le Gal
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2010-06-07
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  8     ISSN:  1538-7836     ISO Abbreviation:  J. Thromb. Haemost.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-10-28     Completed Date:  2011-03-07     Revised Date:  2012-04-05    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  England    
Other Details:
Languages:  eng     Pagination:  1716-22     Citation Subset:  IM    
Copyright Information:
© 2010 International Society on Thrombosis and Haemostasis.
Affiliation:
Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Cardiology / methods
Cohort Studies
Humans
Incidence
Outcome Assessment (Health Care)
Pulmonary Embolism / diagnosis*,  epidemiology,  radiography*
Randomized Controlled Trials as Topic
Reproducibility of Results
Risk
Tomography, X-Ray Computed / methods*
Treatment Outcome
Comments/Corrections
Comment In:
J Thromb Haemost. 2012 Mar;10(3):496-8   [PMID:  22212300 ]
J Thromb Haemost. 2010 Dec;8(12):2835-6   [PMID:  20854375 ]

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