Patient-Level, Institutional, and Temporal Variations in Use of Imaging Modalities to Confirm Pulmonary Embolism
- Type de publi. : Article dans une revue
- Date de publi. : 01/05/2020
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Auteurs :
Ghazaleh MehdipoorDavid JiménezLaurent BertolettiÁngeles FidalgoJuan Francisco Sanchez Muñoz-TorreroJosé Pedro Gonzalez-MartinezÁngeles Blanco-MolinaMiguel Ángel AibarPierre-Benoît BonnefoyRamin KhorasaniMartin PrinceBehnood BikdeliManuel MonrealMaría Dolores AdarragaMaría AgudPedro Azcarate-AgüeroJesús AibarJoaquín AlfonsoCristina AmadoJuan Ignacio ArcelusAitor BallazRaquel BarbaCristina Barbagelata, Manuel BarrónBelén Barrón-AndrésAna María CamonInmaculada CañasJuan CriadoCristina De AncosJavier De MiguelJorge del ToroPablo Demelo-RodríguezCarmen Díaz-PedrocheJosé Antonio Díaz-PeromingoRaquel Díaz-SimónJavier Díez-SierraIrene Milagros DomínguezJosé Carlos EscribanoAna Isabel FarfánCarmen Fernández-CapitánJosé Luis Fernández-ReyesKatia FloresCarme FontLlorenç FontIria FranciscoCristina GabaraFrancisco Galeano-ValleMaría Ángeles GarcíaFerran García-BragadoMaría García-GarcíaAránzazu García-RasoOlga Gavín-BlancoOlga Gavín-SebastiánMaría Carmen GayolAída Gil-DíazCovadonga Gómez-CuervoEnric GrauJavier Gutiérrez-GuisadoLuis Hernández-BlascoMarina IglesiasLuis Jara-PalomaresMaría Jesús JarasMaría Dolores JoyaInés JouBeatriz LacruzAntonio LaluezaRamón LecumberriJorge LimaPilar LlamasJosé Luis LoboLuciano López-JiménezPatricia López-MiguelJuan José López-NúñezRaquel López-ReyesJuan Bosco López-SáezManuel Alejandro LorenteAlicia LorenzoMónica LoringMarina LumbierresOlga MadridanoAna MaestrePablo Javier MarchenaMiguel Martín-FernándezJavier Miguel Martín-GuerraFrancisco Martín-MartosMeritxel MelladoMaría Isabel MercadoJorge MoisésMaría del Valle MoralesArturo Muñoz-BlancoDiego Muñoz-GuglielmettiJosé Antonio NietoManuel Jesús NúñezMaría Carmen Olivares, Clara Ortega-MichelMaría Dolores Ortega-RecioJeisson OsorioRemedios OteroDiana ParedesPedro ParraVirginia ParraJosé María PedrajasGaladriel PellejeroCristina Pérez-DuctorMaría Asunción Pérez-JacoísteDavid PesántezJosé Antonio PorrasJosé PortilloLluis ReigAntoni Riera-MestreAgustina RivasAna Rodríguez-CoboIrene Rodríguez-GalánConsolación Rodríguez-MatuteVladimir RosaCarmen María RubioPedro Ruiz-ArtachoNuria Ruiz-GiménezJusto Ruiz-RuizPablo Ruiz-SadaPaloma Ruiz-TorregrosaJoan Carles SahuquilloGiorgina SalgueiroÁngel SampérizTeresa SanchoSilvia SolerSusana SuárezJosé María SuriñachGregorio TiberioMaría Isabel TorresCarlos TolosaJavier Trujillo-SantosFernando UresandiEsther UsandizagaReina ValleJeronimo Ramón VelaGemma VidalPaula VillaresCarles ZamoraPaula GutiérrezFernando Javier VázquezThomas VanasscheChristophe VandenbrielePeter VerhammeJana HirmerovaRadovan MalýEstuardo SalgadoIlham BenzidiaAlessandra Bura-RiviereBenjamin CrichiPhilippe DebourdeauDominique Farge-BancelHélène HelferIsabelle MahéFarès MoustafaGéraldine PoenouSebastian SchellongAndrei BraesterBenjamin BrennerInna TzoranMaría AmitranoFranca BiloraCristiano BortoluzziBarbara BrandolinEugenio BucheriniMaurizio CiammaichellaDonatella ColaizzoFrancesco DentaliPierpaolo Di MiccoEliana GiammarinoElvira GrandoneFabio MaggiSara MangiacapraDaniela MastroiacovoRosa MaidaFederica PaceRaffaele PesaventoFulvio PomeroPaolo PrandoniRoberto QuintavallaAnna RocciCarmine SiniscalchiEros TiraferriAntonella TufanoAdriana VisonàNgoc Vo HongBeniamino ZalunardoRoberts KalejsDana KigitovicaAndris SkrideMelanie FerreiraJose MeirelesAbilio ReisMarijan BosevskiGorjan KrstevskiMarija ZdraveskaHenri BounameauxLucia MazzolaiJoseph CapriniAlfonso TafurIdo WeinbergHannah WilkinsHanh My Bui
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Organismes :
Cardiovascular Research Foundation [New York, NY, USA]
Centre d'Investigation Clinique - Epidémiologie Clinique [CHU Saint-Etienne]
Santé Ingénierie Biologie Saint-Etienne
Service de Médecine vasculaire et thérapeutique [CHU de Saint-Etienne]
- Publié dans Circulation: Cardiovascular Imaging le 24/10/2020
Résumé : Background: The choice of the imaging modality for diagnosis of pulmonary embolism (PE) could be influenced by provider, patient or hospital characteristics, or over time. However, little is known about the choice of the diagnostic modalities in practice. The aim of this study was to evaluate the variations in the use of imaging modalities for patients with acute PE. Methods: Using the data from Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective international registry of patients with venous thromboembolism (March 2001–January 2019), we explored the imaging modalities used in patients with acute PE. The imaging modalities included computed tomography pulmonary angiography, ventilation/perfusion scanning, pulmonary angiography, a combination of these tests, or PE signs and symptoms plus imaging-confirmed proximal deep vein thrombosis but no chest imaging. Results: Among 38 025 patients with confirmed PE (53.1% female, age: 67.3±17 years), computed tomography pulmonary angiography was the dominant modality of diagnosis in all RIETE enrollees (78.2% [99% CI, 77.6–78.7]); including pregnant patients (58.9% [99% CI, 47.7%–69.4%]) and patients with severe renal insufficiency (62.5% [99% CI, 59.9–65.0]). A greater proportion of patients underwent ventilation/perfusion scanning in larger hospitals compared with smaller hospitals (13.1% versus 7.3%, P <0.001). The use of computed tomography pulmonary angiography varied between 13.3% and 98.3% across the countries, and its use increased over time (46.5% in 2002 to 91.7% in 2018, P <0.001). Conclusions: In a large multinational PE registry, variations were observed in the use of imaging modalities according to patient or institutional factors and over time. However, computed tomography pulmonary angiography was the dominant modality of diagnosis, even in pregnancy and severe renal insufficiency. The safety, costs, and downstream effects of these tests on PE-related and non-PE-related outcomes warrant further investigation.
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