Prevalence and significance of nonthromboembolic findings on chest computed tomography angiography performed to rule out pulmonary embolism: A multicenter study of 1,025 emergency department patients

Peter B. Richman, Mark Courtney, Jeremy Friese, Jessica Matthews, Adam Field, Roland Petri, Jeffrey Kline

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Objectives: To evaluate the hypothesis that computed tomography (CT) angiography often yields a result interpreted as an alternative diagnosis to pulmonary embolism (PE) in emergency department (ED) patients. Methods: This was a multicenter, retrospective, and secondary analysis of consecutive patients in three academic emergency departments. ED patients with symptoms suspicious for PE were included. CT angiography was ordered at the discretion of the treating physician; patients were identified by query of the electronic medical record. Board-certified radiologists gave CT readings, which were reviewed by two independent emergency physicians who categorized the non-PE findings into one of four acuity categories: A = requiring specific and immediate intervention, B = requiring specific action on follow-up, C = requiring no action, and D = indeterminate findings. Results: The prevalence of PE among the 1,025 patients studied was 10% (95% CI = 8% to 12%). In the 921 patients without PE, the mean prevalences (ranges between sites) of concordant categorized non-PE findings were: A = 7% (range 3%-11%), B = 10% (7%-13%), C = 17% (10%-20%), D = 4% (0%-8%), and no ancillary finding = 41% (29% to 45%). The most common category A findings included infiltrate or consolidation suggesting pneumonia (81%), aortic aneurysm or dissection (7%), and mass suggesting undiagnosed malignancy (7%). The overall unweighted agreement was 80% (κ = 0.72) and weighted agreement was 93% (κw = 0.84). Conclusions: In ED patients with suspected PE, the CT angiogram frequently provides evidence suggesting an important alternative diagnosis to PE. Pulmonary infiltrate suggesting pneumonia was the most common non-PE finding.

Original languageEnglish (US)
Pages (from-to)642-647
Number of pages6
JournalAcademic Emergency Medicine
Volume11
Issue number6
DOIs
StatePublished - Jun 2004
Externally publishedYes

Fingerprint

Pulmonary Embolism
Multicenter Studies
Hospital Emergency Service
Thorax
Embolism
Pneumonia
Tomography
Physicians
Aortic Aneurysm
Electronic Health Records
Computed Tomography Angiography
Dissection
Reading
Angiography
Emergencies
Lung
Neoplasms

Keywords

  • Computed tomography
  • Decision making
  • Diagnosis
  • Emergency department
  • Interobserver agreement
  • Multicenter
  • Venous thromboembolism

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Prevalence and significance of nonthromboembolic findings on chest computed tomography angiography performed to rule out pulmonary embolism : A multicenter study of 1,025 emergency department patients. / Richman, Peter B.; Courtney, Mark; Friese, Jeremy; Matthews, Jessica; Field, Adam; Petri, Roland; Kline, Jeffrey.

In: Academic Emergency Medicine, Vol. 11, No. 6, 06.2004, p. 642-647.

Research output: Contribution to journalArticle

@article{fc894fca51e94cfe940ef788c9afa022,
title = "Prevalence and significance of nonthromboembolic findings on chest computed tomography angiography performed to rule out pulmonary embolism: A multicenter study of 1,025 emergency department patients",
abstract = "Objectives: To evaluate the hypothesis that computed tomography (CT) angiography often yields a result interpreted as an alternative diagnosis to pulmonary embolism (PE) in emergency department (ED) patients. Methods: This was a multicenter, retrospective, and secondary analysis of consecutive patients in three academic emergency departments. ED patients with symptoms suspicious for PE were included. CT angiography was ordered at the discretion of the treating physician; patients were identified by query of the electronic medical record. Board-certified radiologists gave CT readings, which were reviewed by two independent emergency physicians who categorized the non-PE findings into one of four acuity categories: A = requiring specific and immediate intervention, B = requiring specific action on follow-up, C = requiring no action, and D = indeterminate findings. Results: The prevalence of PE among the 1,025 patients studied was 10{\%} (95{\%} CI = 8{\%} to 12{\%}). In the 921 patients without PE, the mean prevalences (ranges between sites) of concordant categorized non-PE findings were: A = 7{\%} (range 3{\%}-11{\%}), B = 10{\%} (7{\%}-13{\%}), C = 17{\%} (10{\%}-20{\%}), D = 4{\%} (0{\%}-8{\%}), and no ancillary finding = 41{\%} (29{\%} to 45{\%}). The most common category A findings included infiltrate or consolidation suggesting pneumonia (81{\%}), aortic aneurysm or dissection (7{\%}), and mass suggesting undiagnosed malignancy (7{\%}). The overall unweighted agreement was 80{\%} (κ = 0.72) and weighted agreement was 93{\%} (κw = 0.84). Conclusions: In ED patients with suspected PE, the CT angiogram frequently provides evidence suggesting an important alternative diagnosis to PE. Pulmonary infiltrate suggesting pneumonia was the most common non-PE finding.",
keywords = "Computed tomography, Decision making, Diagnosis, Emergency department, Interobserver agreement, Multicenter, Venous thromboembolism",
author = "Richman, {Peter B.} and Mark Courtney and Jeremy Friese and Jessica Matthews and Adam Field and Roland Petri and Jeffrey Kline",
year = "2004",
month = "6",
doi = "10.1197/j.aem.2003.12.021",
language = "English (US)",
volume = "11",
pages = "642--647",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Prevalence and significance of nonthromboembolic findings on chest computed tomography angiography performed to rule out pulmonary embolism

T2 - A multicenter study of 1,025 emergency department patients

AU - Richman, Peter B.

AU - Courtney, Mark

AU - Friese, Jeremy

AU - Matthews, Jessica

AU - Field, Adam

AU - Petri, Roland

AU - Kline, Jeffrey

PY - 2004/6

Y1 - 2004/6

N2 - Objectives: To evaluate the hypothesis that computed tomography (CT) angiography often yields a result interpreted as an alternative diagnosis to pulmonary embolism (PE) in emergency department (ED) patients. Methods: This was a multicenter, retrospective, and secondary analysis of consecutive patients in three academic emergency departments. ED patients with symptoms suspicious for PE were included. CT angiography was ordered at the discretion of the treating physician; patients were identified by query of the electronic medical record. Board-certified radiologists gave CT readings, which were reviewed by two independent emergency physicians who categorized the non-PE findings into one of four acuity categories: A = requiring specific and immediate intervention, B = requiring specific action on follow-up, C = requiring no action, and D = indeterminate findings. Results: The prevalence of PE among the 1,025 patients studied was 10% (95% CI = 8% to 12%). In the 921 patients without PE, the mean prevalences (ranges between sites) of concordant categorized non-PE findings were: A = 7% (range 3%-11%), B = 10% (7%-13%), C = 17% (10%-20%), D = 4% (0%-8%), and no ancillary finding = 41% (29% to 45%). The most common category A findings included infiltrate or consolidation suggesting pneumonia (81%), aortic aneurysm or dissection (7%), and mass suggesting undiagnosed malignancy (7%). The overall unweighted agreement was 80% (κ = 0.72) and weighted agreement was 93% (κw = 0.84). Conclusions: In ED patients with suspected PE, the CT angiogram frequently provides evidence suggesting an important alternative diagnosis to PE. Pulmonary infiltrate suggesting pneumonia was the most common non-PE finding.

AB - Objectives: To evaluate the hypothesis that computed tomography (CT) angiography often yields a result interpreted as an alternative diagnosis to pulmonary embolism (PE) in emergency department (ED) patients. Methods: This was a multicenter, retrospective, and secondary analysis of consecutive patients in three academic emergency departments. ED patients with symptoms suspicious for PE were included. CT angiography was ordered at the discretion of the treating physician; patients were identified by query of the electronic medical record. Board-certified radiologists gave CT readings, which were reviewed by two independent emergency physicians who categorized the non-PE findings into one of four acuity categories: A = requiring specific and immediate intervention, B = requiring specific action on follow-up, C = requiring no action, and D = indeterminate findings. Results: The prevalence of PE among the 1,025 patients studied was 10% (95% CI = 8% to 12%). In the 921 patients without PE, the mean prevalences (ranges between sites) of concordant categorized non-PE findings were: A = 7% (range 3%-11%), B = 10% (7%-13%), C = 17% (10%-20%), D = 4% (0%-8%), and no ancillary finding = 41% (29% to 45%). The most common category A findings included infiltrate or consolidation suggesting pneumonia (81%), aortic aneurysm or dissection (7%), and mass suggesting undiagnosed malignancy (7%). The overall unweighted agreement was 80% (κ = 0.72) and weighted agreement was 93% (κw = 0.84). Conclusions: In ED patients with suspected PE, the CT angiogram frequently provides evidence suggesting an important alternative diagnosis to PE. Pulmonary infiltrate suggesting pneumonia was the most common non-PE finding.

KW - Computed tomography

KW - Decision making

KW - Diagnosis

KW - Emergency department

KW - Interobserver agreement

KW - Multicenter

KW - Venous thromboembolism

UR - http://www.scopus.com/inward/record.url?scp=2942559227&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=2942559227&partnerID=8YFLogxK

U2 - 10.1197/j.aem.2003.12.021

DO - 10.1197/j.aem.2003.12.021

M3 - Article

C2 - 15175202

AN - SCOPUS:2942559227

VL - 11

SP - 642

EP - 647

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 6

ER -