Pulmonary embolism incidence is increasing with use of spiral computed tomography. Export

@article{citeulike:3270849, abstract = {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.}, address = {Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.}, author = {DeMonaco, N. A. and Dang, Q. and Kapoor, W. N. and Ragni, M. V.}, citeulike-article-id = {3270849}, citeulike-linkout-0 = {http://dx.doi.org/10.1016/j.amjmed.2008.02.035}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/18589057}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=18589057}, doi = {10.1016/j.amjmed.2008.02.035}, issn = {1555-7162}, journal = {The American journal of medicine}, keywords = {broker, honest, mars}, month = {July}, number = {7}, pages = {611--617}, posted-at = {2008-09-16 01:21:45}, priority = {0}, title = {Pulmonary embolism incidence is increasing with use of spiral computed tomography.}, url = {http://dx.doi.org/10.1016/j.amjmed.2008.02.035}, volume = {121}, year = {2008} }

TY - JOUR ID - citeulike:3270849 L3 - citeulike-article-id:3270849 N2 - 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. IS - 7 JF - The American journal of medicine SN - 1555-7162 AD - Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. EP - 617 TI - Pulmonary embolism incidence is increasing with use of spiral computed tomography. VL - 121 SP - 611 KW - broker KW - honest KW - mars AU - DeMonaco, NA AU - Dang, Q AU - Kapoor, WN AU - Ragni, MV PY - 2008/07// UR - http://dx.doi.org/10.1016/j.amjmed.2008.02.035 ER -