CT Pulmonary Angiography Tied to Embolism Overdiagnosis

Higher pulmonary embolism incidence and lower case fatality after CT pulmonary angiography

TUESDAY, May 10 (HealthDay News) -- In patients with pulmonary embolism (PE), computed tomographic pulmonary angiography (CTPA) is associated with overdiagnosis reflected by increasing incidence, limited change in mortality, and reduced case fatality, according to a study published in the May 9 issue of the Archives of Internal Medicine.

Renda Soylemez Wiener, M.D., M.P.H., from the Boston University School of Medicine, and colleagues investigated whether CTPA results in overdiagnosis of PE in the United States. Data from the Nationwide Inpatients Sample and Multiple Cause-of-Death databases were used to compare age-adjusted incidence, mortality, and treatment complications (secondary thrombocytopenia or gastrointestinal tract or intracranial hemorrhage) of PE before (1993 to 1998) and after (1998 to 2006) the introduction of CTPA.

The investigators found that PE incidence was stable before CTPA but increased by 81 percent after CTPA, from 62.1 to 112.3 per 100,000. PE mortality was reduced by 8 percent before CTPA, from 13.4 to 12.3 per 100,000, and showed a smaller but significant reduction from 12.3 to 11.9 per 100,000 after CTPA. Case fatality decreased slightly but significantly from 13.2 to 12.1 percent (8 percent decrease) before CTPA and substantially after CTPA (36 percent decrease, from 12.1 to 7.8 percent). The PE complication rate was stable before CTPA but increased after CTPA by 71 percent, from 3.1 to 5.3 per 100,000.

"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," the authors write.

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