| Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. | |
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MedLine Citation:
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PMID: 21555660 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: 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 (finding clinically unimportant emboli and exposing patients to harms from unnecessary treatment). METHODS: To assess the impact of CTPA on national PE incidence, mortality, and treatment complications, we conducted a time trend analysis using the Nationwide Inpatient Sample and Multiple Cause-of-Death databases. We compared age-adjusted incidence, mortality, and treatment complications (in-hospital gastrointestinal tract or intracranial hemorrhage or secondary thrombocytopenia) of PE among US adults before (1993-1998) and after (1998-2006) CTPA was introduced. RESULTS: Pulmonary embolism incidence was unchanged before CTPA (P = .64) but increased substantially after CTPA (81% increase, from 62.1 to 112.3 per 100,000; P < .001). Pulmonary embolism mortality decreased during both periods: more so before CTPA (8% reduction, from 13.4 to 12.3 per 100,000; P < .001) than after (3% reduction, from 12.3 to 11.9 per 100,000; P = .02). Case fatality improved slightly before (8% decrease, from 13.2% to 12.1%; P = .02) and substantially after CTPA (36% decrease, from 12.1% to 7.8%; P < .001). Meanwhile, CTPA was associated with an increase in presumed complications of anticoagulation for PE: before CTPA, the complication rate was stable (P = .24), but after it increased by 71% (from 3.1 to 5.3 per 100,000; P < .001). CONCLUSIONS: 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. |
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Authors:
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Renda Soylemez Wiener; Lisa M Schwartz; Steven Woloshin |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S. |
Journal Detail:
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Title: Archives of internal medicine Volume: 171 ISSN: 1538-3679 ISO Abbreviation: Arch. Intern. Med. Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-05-10 Completed Date: 2011-07-21 Revised Date: 2012-05-09 |
Medline Journal Info:
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Nlm Unique ID: 0372440 Medline TA: Arch Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 831-7 Citation Subset: AIM; IM |
Affiliation:
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The Pulmonary Center, Boston University School of Medicine, Massachusetts 02118, USA. rwiener@bu.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angiography
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trends* Female Humans Incidence Male Middle Aged Pulmonary Embolism / mortality*, radiography* Time Factors Tomography, X-Ray Computed United States / epidemiology |
| Grant Support | |
ID/Acronym/Agency:
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K07 CA138772/CA/NCI NIH HHS; K07 CA138772-02/CA/NCI NIH HHS; K07 CA138772-04/CA/NCI NIH HHS |
| Comments/Corrections | |
Comment In:
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Arch Intern Med. 2011 Nov 28;171(21):1962; author reply 1962-3
[PMID:
22123814
]
Arch Intern Med. 2011 May 9;171(9):837-9 [PMID: 21555661 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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