Related Experiment Videos
Changing practice patterns in the workup of pulmonary embolism
C I Henschke1, I Mateescu, D F Yankelevitz
1Department of Radiology, New York Hospital-Cornell Medical Center, NY 10021, USA.
Chest
|April 1, 1995
Summary
Physician behavior regarding pulmonary embolism diagnosis did not change significantly between 1988 and 1991. More diagnostic tests were used in 1991, but anticoagulation rates remained the same, indicating a need for improved screening guidelines.
Area of Science:
- Medical Diagnostics
- Radiology
- Cardiovascular Medicine
Background:
- Pulmonary embolism (PE) diagnosis relies on various imaging modalities.
- Selective pulmonary angiography is the gold standard but infrequently used.
- Ventilation/perfusion (V/Q) scans are common but require further evaluation for low/intermediate probability scans.
Purpose of the Study:
- To assess changes in physician diagnostic behavior for suspected pulmonary embolism from 1988 to 1991.
- To evaluate the impact of diagnostic advancements on clinical practice patterns.
Main Methods:
- Retrospective review of inpatient data from The New York Hospital-Cornell Medical Center.
- Analysis of diagnostic procedures (V/Q scans, sonograms, venograms, angiograms) and treatments for suspected PE.
- Comparison of data from 1988 and 1991.
Main Results:
- No significant change in the distribution of V/Q scan categories or anticoagulation therapy rates between 1988 and 1991.
- Increased utilization of venous leg sonograms in 1991.
- Decreased use of pulmonary angiograms and venograms in 1991, without significant cost alteration.
Conclusions:
- Despite increased use of ancillary diagnostic tests, anticoagulation rates for pulmonary embolism remained unchanged.
- Current diagnostic strategies for PE may not be optimally aligned with clinical outcomes.
- Development of explicit screening guidelines considering local prevalence and practice patterns is warranted.