Clinical validity of a negative computed tomography scan in patients with suspected pulmonary embolism: a systematic review
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Summary
This summary is machine-generated.Computed tomography (CT) effectively rules out pulmonary embolism (PE) with a negative likelihood ratio of 0.07. This diagnostic accuracy is comparable to conventional pulmonary angiography, ensuring patient safety.
Area Of Science
- Radiology
- Cardiovascular Imaging
- Pulmonary Medicine
Background
- Clinical validity of computed tomography (CT) for diagnosing peripheral pulmonary embolism remains uncertain.
- Insufficient sensitivity of CT for peripheral pulmonary embolism is a primary limitation.
Purpose Of The Study
- To systematically review studies evaluating CT-based approaches for ruling out pulmonary embolism (PE).
Main Methods
- Searched PubMed, MEDLINE, EMBASE, CRISP, metaRegister, and Cochrane for English-language studies (1990-2004).
- Included studies using contrast-enhanced chest CT, with >30 patients and 3-month follow-up, to rule out acute PE.
- Extracted data on demographics, venous thromboembolic events (VTEs), CT modality, false negatives, and PE-related mortality.
Main Results
- Fifteen studies (3500 patients) were analyzed.
- Overall negative likelihood ratio (NLR) for VTE after negative CT was 0.07 (95% CI, 0.05-0.11); negative predictive value (NPV) was 99.1% (95% CI, 98.7%-99.5%).
- Overall NLR for PE-related mortality was 0.01 (95% CI, 0.01-0.02); overall NPV was 99.4% (95% CI, 98.7%-99.9%).
Conclusions
- CT scans demonstrate clinical validity comparable to conventional pulmonary angiography for ruling out pulmonary embolism.
- CT is a reliable tool for excluding PE, with high negative predictive value and low negative likelihood ratio for VTE and mortality.