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CTA utilization for evaluation of suspected pulmonary embolism in a tertiary pediatric emergency department

      Highlights

      • CT angiography orders for pulmonary embolism have been increasing without any increased detection of PE in children.
      • The netection of ancillary findings on chest CT angiography increased as the number of CT angiography exams has increased, but the rate of ancillary findings did not match the rate of CT angiography ordering. The number of CT angiography exam positive for ancillary findings but negative for PE increased along the number of exams.
      • Chest radiographs showed the same ancillary findings as in CT angiography in 38% of patients.

      Abstract

      Objective

      To evaluate changes in the utilization of computed tomography angiography (CTA) for evaluating suspected pulmonary embolism (PE) and the positive rate of ancillary for those studies negative for PE in the last 13 years.

      Materials and methods

      A retrospective review of patient ≤ 20 years of age who underwent a chest CT angiography to rule out PE was performed in a 13-year-period. CT angiographies were grouped into three categories: Positive for PE, negative for PE and positive for ancillary findings, and negative for any pathology. From the exams with ancillary findings, we examined how many of these had a chest radiograph perform within 24 h prior to the CTA and how many of them had an impression stating the same conclusion as the CTA.

      Results

      307 chest CT angiographies for suspected PE were included. 50 (16%) were reported as positive for PE and 91 (30%) were negative for PE but positive for ancillary findings. The most frequent ancillary findings were pneumonia (n = 26) and pleural effusion (n = 11). Out of 91, 73 patients had a previous chest radiograph and 28 of them reported a similar diagnosis than the CTA. The number of CT angiographies indicated for PE increased by 3.2 studies per year. The rate of CT angiographies positive for ancillary findings (slope = 1.5) and positive for PE (slope = 0.3) remained similar throughout the same period.

      Conclusions

      CTA orders for PE have been increasing without any increased detection of PE or ancillary findings in children.

      Keywords

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