Document Detail

Is bilateral lower extremity compression sonography useful and cost-effective in the evaluation of suspected pulmonary embolism?
MedLine Citation:
PMID:  8249744     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Because deep venous thrombosis is clinically linked with pulmonary embolism and often treated similarly, we sought to assess the usefulness of obtaining bilateral lower extremity compression sonograms when findings on ventilation-perfusion lung scans indicate a low or indeterminate probability of pulmonary embolism. Demonstration of deep venous thrombosis would provide a rationale for treating both pulmonary embolism and deep venous thrombosis. MATERIALS AND METHODS: Two hundred twenty-three consecutive patients with suspected pulmonary embolism had ventilation-perfusion lung scans and concurrent bilateral lower extremity compression sonograms; 34 also had pulmonary arteriography. RESULTS: In 75 cases, the results of ventilation-perfusion lung scanning indicated an indeterminate probability of pulmonary embolism. Evidence of thrombosis was seen on sonograms in 11 of these 75. In the remaining 64, 17 underwent pulmonary arteriography and four (24%) had pulmonary embolism. Findings on lung scans indicated a low probability of pulmonary embolism in 70 of 223 patients. Evidence of thrombosis was seen on sonograms in 11 of these 70. Five of the remaining 59 underwent pulmonary arteriography and one (20%) had pulmonary embolism. According to the 1993 Medicare Fee Schedule, if all 145 patients whose lung scans were nondiagnostic had sonography and only those with normal sonograms had pulmonary arteriography, the professional and hospital charges would be $359,552. If all 145 had pulmonary arteriography without sonography, the charges would be $395,031. CONCLUSION: If ventilation-perfusion lung scans indicate a low or an indeterminate probability of pulmonary embolism and bilateral lower extremity compression sonography is performed, only those patients with normal sonographic findings would need further study. Thus, 15% (22/145) of patients could be spared pulmonary arteriography, and the estimated savings in cost would be 9%.
R P Beecham; G S Dorfman; J J Cronan; M P Spearman; T P Murphy; F H Scola
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  AJR. American journal of roentgenology     Volume:  161     ISSN:  0361-803X     ISO Abbreviation:  AJR Am J Roentgenol     Publication Date:  1993 Dec 
Date Detail:
Created Date:  1993-12-28     Completed Date:  1993-12-28     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  7708173     Medline TA:  AJR Am J Roentgenol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1289-92     Citation Subset:  AIM; IM    
Department of Diagnostic Imaging, Rhode Island Hospital-Brown University School of Medicine, Providence 02903.
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MeSH Terms
Cost-Benefit Analysis
Costs and Cost Analysis
Leg / blood supply*
Lung / radionuclide imaging
Middle Aged
Pulmonary Artery / radiography
Pulmonary Embolism / diagnosis,  epidemiology,  etiology*
Retrospective Studies
Risk Factors
Thrombophlebitis / complications,  epidemiology,  ultrasonography*

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