Pulmonary embolism incidence is increasing with use of spiral computed tomography

被引:110
作者
DeMonaco, Nicholas A. [1 ]
Dang, Qianyu [2 ]
Kapoor, Wishwa N. [2 ]
Ragni, Margaret V. [1 ,3 ]
机构
[1] Univ Pittsburgh, Hemophilia Ctr Western, Div Hematol Oncol, Sch Med,Dept Med, Pittsburgh, PA 15213 USA
[2] Univ Pittsburgh, Ctr Healthcare Res, Dept Gen Internal Med, Pittsburgh, PA 15260 USA
[3] Hemophilia Ctr Western Penn, Pittsburgh, PA USA
关键词
hospital discharges; pulmonary embolism; spiral computed tomography; venous thromboembolism;
D O I
10.1016/j.amjmed.2008.02.035
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Pulmonary embolism causes significant morbidity in hospitalized patients, yet few studies have explored the impact of spiral computed tomography (CT) scanning on diagnosis and clinical outcome. METHODS: Incidence rates of pulmonary embolism, chest and spiral CT rates, D-dimer assay, anticoagulation, and in-hospital mortality were assessed on statewide pulmonary embolism discharge data (1997-2001) from the Pennsylvania Health Care Cost Containment Council. RESULTS: The incidence of pulmonary embolism increased from 47 to 63 per 100,000 patients from 1997 to 2001 (mean of 0.004% per year, P <.001). Mean pulmonary embolism incidence rates were higher for African American patients (0.031% per year higher than for white patients), patients aged 70 years or more (0.007% higher than for patients aged < 70 years), and female patients (0.013% higher than for male patients) (all P <.001). Concomitantly, the proportion undergoing CT (including spiral) scans increased from 23.23% to 45.18% (odds ratio = 1.30; P <.001), controlling for age, gender, race, and cancer, whereas rates for other procedures remained unchanged. By comparing 1999 and before with 2000 and after, there was a significant decrease in the 2 highest Atlas Severity of Illness categories (49.4%-37.7%) and a significant increase in the 3 lowest categories (50.6%-62.3%; P <.001). The risk of in- hospital deaths among patients with pulmonary embolism decreased in this period from 12.8% to 11.1% (P <.001). CONCLUSION: The incidence of pulmonary embolism is increasing with the increasing use of spiral CT scans, with a lower severity of illness and lower mortality, suggesting the increase is due to earlier diagnosis. (c) 2008 Elsevier Inc. All rights reserved.
引用
收藏
页码:611 / 617
页数:7
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