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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical ImagingAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical features and outcome of pulmonary embolism in children.Br J Haematol. 2008; 142: 808-818
- Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE.Blood. 1994; 83: 1251-1257
- Pulmonary embolism in children.J Pediatr Surg. 1981; 16: 385-391
- Dramatic increase in venous thromboembolism in children’s hospitals in the United States from 2001 to 2007.Pediatrics. 2009; 124: 1001-1008
- Pulmonary embolism-experience at a single children’s hospital.Thromb Res. 2007; 119: 699-703
- Pulmonary embolism in children.Pediatr Clin North Am. 2018; 65: 495-507
- Detection of pulmonary embolism in high-risk children.J Pediatr. 2016; 178: 214-218.e213
- Pulmonary embolism in children.AJR Am J Roentgenol. 2015; 204: 1278-1288
- Beyond the pulmonary arteries: alternative diagnoses in children with MDCT pulmonary angiography negative for pulmonary embolism.AJR Am J Roentgenol. 2009; 193: 888-894
- MDCT pulmonary angiography evaluation of pulmonary embolism in children.AJR Am J Roentgenol. 2009; 192: 1246-1252
- Radiation risk to children from computed tomography.Pediatrics. 2007; 120: 677-682
- Computed tomography—an increasing source of radiation exposure.N Engl J Med. 2007; 357: 2277-2284
- Medical radiation exposure in the U.S. in 2006: preliminary results.Health Phys. 2008; 95: 502-507
- Increased emergency department computed tomography use for common chest symptoms without clear patient benefits.J Am Board Fam Med. 2012; 25: 33-41
- The new era of medical imaging—progress and pitfalls.N Engl J Med. 2006; 354: 2822-2828
- Pulmonary embolism in the pediatric emergency department.Pediatrics. 2013; 132: 663-667
- Children suspected of having pulmonary embolism: multidetector CT pulmonary angiography—thromboembolic risk factors and implications for appropriate use.Radiology. 2012; 262: 242-251
- Estimated case fatality rate of pulmonary embolism, 1979 to 1998.Am J Cardiol. 2004; 93: 1197-1199
- U.S. trends in computed tomography use and diagnoses in emergency department visits by patients with symptoms suggestive of pulmonary embolism, 2001–2009.Acad Emerg Med. 2013; 20: 1033-1040
- The uncritical use of high-tech medical imaging.N Engl J Med. 2010; 363: 4-6
- The defensive practice of medicine: myth or reality.Milbank Mem Fund Q. 1972; 50: 69-97
- Overdiagnosis of pulmonary embolism: definition, causes and implications.Breathe (Sheff). 2019; 15: 46-53
- ACR manual on contrast media.ACRhttps://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdfDate: 2020Date accessed: August 1, 2020
- Radiation, CT, and children: the simple answer is … it’s complicated.Radiology. 2009; 252: 4-6
- Chest CT in infants and children.Eur J Radiol. 2013; 82: 1108-1117
- Pulmonary embolism in pediatric patients survey of CT pulmonary angiography practices and policies.Acad Radiol. 2010; 17: 1543-1549
- Pulmonary atelectasis: a frequent alternative diagnosis in patients undergoing CT-PA for suspected pulmonary embolism.Emerg Radiol. 2004; 10: 282-286
Article info
Publication history
Published online: January 04, 2021
Accepted:
December 26,
2020
Received in revised form:
August 1,
2020
Received:
March 28,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
