Featured Research

from universities, journals, and other organizations

Over-diagnosis of pulmonary embolisms as a result of computed tomography pulmonary angiography, study suggests

Date:
May 9, 2011
Source:
Boston University Medical Center
Summary:
Researchers have found that computed tomography pulmonary angiography (CTPA), meant to improve detection of life-threatening pulmonary embolisms, has led to over-diagnosis and over treatment of this condition. These findings may continue to grow worse as the as the use of CT scans continue to rise.

Researchers from Boston University School of Medicine (BUSM) have found that computed tomography pulmonary angiography (CTPA), meant to improve detection of life-threatening pulmonary embolisms (PE), has led to over-diagnosis and over treatment of this condition. These findings, which appear in May 9 issue of the Archives of Internal Medicine. may continue to grow worse as the as the use of CT scans continue to rise, researchers say.

The introduction in 1998 of multi-detector row CTPA revolutionized the way physicians approach PE. Many assumed this highly sensitive test would improve outcomes of this deadly disease by detecting and allowing treatment of emboli that were previously missed. CTPA rapidly spread into practice, largely replacing other tests for PE such as ventilation-perfusion scans and invasive pulmonary angiography. Several institutions reported a seven to 13-fold increase in use of CTPA by 2006, and nationally there was an 11-fold rise in chest CT angiography from 2001 to 2006 in the Medicare fee-for-service population.

In this study, the researchers compared age-adjusted incidence, mortality and treatment complications (in-hospital gastrointestinal tract or intracranial hemorrhage or secondary thrombocytopenia) of PE among United States adults before (1993-1998) and after (1998-2006) CTPA was introduced. They found the incidence of pulmonary embolism was unchanged before CTPA but increased substantially after CTPA, an 81 percent increase, from 62.1 to 112.3 per 100 000. Pulmonary embolism mortality decreased during both periods: more so before the introduction of CTPA (8 percent reduction, from 13.4 to 12.3 per 100 000) than after (3 percent reduction, from 12.3 to 11.9 per 100 000. In addition, they found case fatality improved slightly before CTPA (8 percent decrease, from 13.2 percent to 12.1 percent) and substantially after CTPA (36 percent decrease, from 12.1 percent to 7.8 percent). Meanwhile, CTPA was associated with an increase in presumed complications of anticoagulation for PE: before CTPA, the complication rate was considered stable, but after it increased by 71 percent (from 3.1 to 5.3 per 100 000).

According to the researchers, CTPA has a downside: the detection of emboli that are so small as to be clinically insignificant that will never cause symptoms or death. "Over-diagnosis matters because it can lead to iatrogenic harm. While a clinically insignificant PE is by definition not harmful, treating such an embolism can cause harm such as bleeding from anticoagulation, which can in the worst case, be fatal," explained lead author Renda Soylemez Wiener, MD, MPH, an assistant professor of medicine at BUSM.

The researchers believe as the use of CT scans continues to rise the problem of over-diagnosis and overtreatment of PEs will likely continue to grow. "Because the harm of treatment can be substantial, including in the worst case death, it is imperative that we do not turn the problem of under-diagnosis into one of over-diagnosis. The researchers feel it is time to strengthen the evidence base: a trial randomizing stable patients with small emboli to observation vs. anticoagulation to help determine whether all patients with PE require treatment. "Better technology allows us to diagnose more emboli, but to minimize harms of over-diagnosis we must learn which ones matter," added Soylemez Wiener.


Story Source:

The above story is based on materials provided by Boston University Medical Center. Note: Materials may be edited for content and length.


Journal Reference:

  1. R. S. Wiener, L. M. Schwartz, S. Woloshin. Time Trends in Pulmonary Embolism in the United States: Evidence of Overdiagnosis. Archives of Internal Medicine, 2011; 171 (9): 831 DOI: 10.1001/archinternmed.2011.178

Cite This Page:

Boston University Medical Center. "Over-diagnosis of pulmonary embolisms as a result of computed tomography pulmonary angiography, study suggests." ScienceDaily. ScienceDaily, 9 May 2011. <www.sciencedaily.com/releases/2011/05/110509161636.htm>.
Boston University Medical Center. (2011, May 9). Over-diagnosis of pulmonary embolisms as a result of computed tomography pulmonary angiography, study suggests. ScienceDaily. Retrieved September 22, 2014 from www.sciencedaily.com/releases/2011/05/110509161636.htm
Boston University Medical Center. "Over-diagnosis of pulmonary embolisms as a result of computed tomography pulmonary angiography, study suggests." ScienceDaily. www.sciencedaily.com/releases/2011/05/110509161636.htm (accessed September 22, 2014).

Share This



More Health & Medicine News

Monday, September 22, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Liberia Pleads for Help to Fight Ebola

Liberia Pleads for Help to Fight Ebola

AP (Sep. 22, 2014) Liberia's finance minister is urging the international community to quickly follow through on pledges of cash to battle Ebola. Bodies are piling up in the capital Monrovia as the nation awaits more help. (Sept. 22) Video provided by AP
Powered by NewsLook.com
Ebola Doctor Says Border Controls Critical

Ebola Doctor Says Border Controls Critical

AP (Sep. 22, 2014) A Florida doctor who helped fight the expanding Ebola outbreak in West Africa says the disease can be stopped, but only if nations quickly step up their response and make border control a priority. (Sept. 22) Video provided by AP
Powered by NewsLook.com
Global Ebola Aid Increasing But Critics Say It's Late

Global Ebola Aid Increasing But Critics Say It's Late

Newsy (Sep. 21, 2014) More than 100 tons of medical supplies were sent to West Africa on Saturday, but aid workers say the global response is still sluggish. Video provided by Newsy
Powered by NewsLook.com
Sierra Leone in Lockdown to Control Ebola

Sierra Leone in Lockdown to Control Ebola

AP (Sep. 21, 2014) Sierra Leone residents remained in lockdown on Saturday as part of a massive effort to confine millions of people to their homes in a bid to stem the biggest Ebola outbreak in history. (Sept. 20) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins