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Patient-Level, Institutional, and Temporal Variations in Use of Imaging Modalities to Confirm Pulmonary Embolism

2020; Lippincott Williams & Wilkins; Volume: 13; Issue: 5 Linguagem: Inglês

10.1161/circimaging.120.010651

1942-0080

Ghazaleh Mehdipoor, David Jiménez, Laurent Bertoletti, Ángeles Fidalgo, Juan Francisco Sánchez Muñoz-Torrero, José Pedro Gonzalez-Martinez, Ángeles Blanco‐Molina, Miguel Ángel Aibar Arregui, P.B. Bonnefoy, Ramin Khorasani, Martin R. Prince, Behnood Bikdeli, Manuel Monréal, María Dolores Adarraga, María Agud, Pedro María Azcárate-Agüero, Jesús Aibar, Joaquín Alfonso, Cristina Amado, Juan I. Arcelus, Aitor Ballaz, Raquel Barba, Manuel Barrón Cristina Barbagelata, B. Barrón‐Andrés, Ana María Camon, Inmaculada Cañas, Juan Criado, Cristina de Ancos, Javier de Miguel‐Díez, J. del Toro, Pablo Demelo‐Rodríguez, Carmen Díaz-Pedroche, José Antonio Díaz‐Peromingo, Raquel Díaz‐Simón, J. Díez-Sierra, Irene Milagros Domínguez, José Carlos Escribano, Ana Isabel Farfán, Carmen Fernández‐Capitán, José Luis Fernández‐Reyes, Katia Flores, Carme Font, Llorenç Font, Iria Francisco, Cristina Gabara, Francisco Galeano‐Valle, María Ángeles García, F. García‐Bragado, Maria P. Garcia-Garcia, Aránzazu García‐Raso, Olga Gavín-Blanco, Olga Gavín‐Sebastián, M.C. Gayol, A. Gil-Díaz, Covadonga Gómez‐Cuervo, Enric Grau, Javier Gutiérrez-Guisado, Luis Blasco, Marina Iglesias, Luis Jara‐Palomares, M.J. Jaras, M.D. Joya, I. Jou, B. Lacruz, Antonio Lalueza, Ramón Lecumberri, Jorge Roberto Perrout de Lima, Pilar Llamas, J.L. Lobo, Luciano López-Jiménez, Patricia López-Miguel, Juan J. López-Núñez, Raquel López-Reyes, J.B. López‐Sáez, M.A. Lorente, Alicia Lorenzo, Mónica Loring, M. Lumbierres, Olga Madridano, Ana M. Maestre, Pablo Javier Marchena, Miguel Martín-Fernández, Javier Miguel Martín Guerra, F. Martín‐Martos, Meritxel Mellado, María Isabel Mercado, Jorge Moisés, María del Valle Morales, Arturo Muñoz Blanco, Diego Muñoz-Guglielmetti, José Antonio Nieto, Manuel Jesús Núñez, Clara Ortega-Michel María Carmen Olivares, María Dolores Ortega-Recio, Jeisson Osorio, Remedios Otero, Diana Paredes-Ruíz, Pedro Parra, Virginia Parra, José María Pedrajas, G. Pellejero, C. Pérez‐Ductor, María Asunción Pérez-Jacoíste, David Pesántez, José Antonio Porras, José Portillo, Lluis Reig, Antoni Riera‐Mestre, A. Rivas, A. Rodríguez-Cobo, Irene Rodríguez-Galán, Consolación Rodríguez-Matute, V. Rosa, Carmen María Rubio, Pedro Ruiz‐Artacho, N. Ruiz‐Giménez, Justo Ruiz-Ruiz, Pablo Ruiz-Sada, Paloma Ruiz-Torregrosa, Joan Carles Sahuquillo, Giorgina Salgueiro, A. Sampériz, Teresa Sancho, Silvia Soler, Susana Suárez, José María Suriñach, G Tiberio, Marı́a Isabel Torres, Carlos Tolosa, Javier Trujillo-Santos, Fernando Uresandi, Esther Usandizaga, Reina Valle, J. Vela, G. Vidal, Paula Villares, Carles Zamora, Paula Gutiérrez, Fernando Javier Vázquez, Thomas Vanassche, Christophe Vandenbriele, Peter Verhamme, Jana Hirmerová, Radován Malý, E. Salgado, Ilham Benzidia, A. Bura-Rivière, Benjamin Crichi, P. Debourdeau, Dominique Farge, H. L. Helfer, Isabelle Mahé, Farès Moustafa, Géraldine Poenou, Sebastian Schellong, Andrei Braester, Benjamin Brenner, Inna Tzoran, María Amitrano, Franca Bilora, Cristiano Bortoluzzi, B. Brandolin, Eugenio Bucherini, Maurizio Ciammaichella, Donatella Colaizzo, Francesco Dentali, Pierpaolo Di Micco, Eliana Giammarino, Elvira Grandone, Fabio Maggi, Sara Mangiacapra, Daniela Mastroiacovo, R. Maida, F. Pace, Raffaele Pesavento, Fulvio Pomero, Paolo Prandoni, Roberto Quintavalla, Anna Rocci, Carmine Siniscalchi, Eros Tiraferri, Antonella Tufano, Adriana Visonà, Ngoc Vo Hong, Beniamino Zalunardo, Verners Roberts Kalējs, Dana Kigitoviča, Andris Skride, Melanie Ferreira, J. Meireles, Abílio Reis, Marijan Bosevski, Gorjan Krstevski, Marija Zdraveska, Henri Bounameaux, Lucia Mazzolai, Joseph A. Caprini, Alfonso Tafur, Ido Weinberg, Hannah Wilkins, My Bui,

Central Venous Catheters and Hemodialysis

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.