Document Detail


Time trends in pulmonary embolism in the United States: evidence of overdiagnosis.
MedLine Citation:
PMID:  21555660     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Renda Soylemez Wiener; Lisa M Schwartz; Steven Woloshin
Publication Detail:
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:
Title:  Archives of internal medicine     Volume:  171     ISSN:  1538-3679     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-10     Completed Date:  2011-07-21     Revised Date:  2013-08-08    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  831-7     Citation Subset:  AIM; IM    
Affiliation:
The Pulmonary Center, Boston University School of Medicine, Massachusetts 02118, USA. rwiener@bu.edu
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MeSH Terms
Descriptor/Qualifier:
Angiography / 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:
K07 CA138772/CA/NCI NIH HHS; K07 CA138772/CA/NCI NIH HHS; K07 CA138772-02/CA/NCI NIH HHS; K07 CA138772-04/CA/NCI NIH HHS
Comments/Corrections
Comment In:
Arch Intern Med. 2011 May 9;171(9):837-9   [PMID:  21555661 ]
Arch Intern Med. 2011 Nov 28;171(21):1962; author reply 1962-3   [PMID:  22123814 ]

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


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