title: Acute pulmonary embolism: impact of selection bias in prospective diagnostic studies. ANTELOPE Study Group. Advances in New Technologies Evaluating the Localization of Pulmonary Embolism.
abstract: We evaluated selection bias in a prospective study of 1,162 consecutive patients with suspected pulmonary embolism. Of these, 983 were eligible, and 627 could actually be included. During two months extensive data were collected on all non-included patients. Finally, our patient characteristics were compared with those of the PIOPED study (1990) and the study of Hull et al. (1994). Compared with included patients, the non-included patients had more often non-diagnostic V/Q scans (50% vs. 36%, p <0.01) and were more often already hospitalized (31% vs. 22%, P = 0.04). The subgroup of patients not included due to refusal or inability to give informed consent (IC) was older (mean age 61 vs. 53 years, P <0.01), more often suffered from malignancies (26% vs. 11%, P <0.01) and frequently had non-diagnostic V/Q scans (57%) as compared to included patients. In our study, 54% of all patients screened was eventually included versus 27% in the PIOPED study. In the PIOPED study patients who had contra-indications for pulmonary angiography were excluded, while in the study of Hull et al. those with inadequate cardiorespiratory reserve were excluded. In studies on new diagnostic technologies, patient selection bias does occur. The potential for such a selection bias should be taken into account when diagnostic strategies are devised to improve their generalizability and acceptability.
authors.affiliation: Department of Radiology, University Medical Center, Utrecht, The Netherlands. I.J.C.Hartmanns@azu.nl
authors.forename: I J
authors.initials: IJ
authors.lastname: Hartmann
authors.forename: M H
authors.initials: MH
authors.lastname: Prins
authors.forename: H R
authors.initials: HR
authors.lastname: Büller
authors.forename: J D
authors.initials: JD
authors.lastname: Banga
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012307:Risk Factors; D015983:Selection Bias; D012680:Sensitivity and Specificity; D013670:Sodium Pertechnetate Tc 99m; D013924:Thrombophlebitis / Q000150:complications / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D016312:Treatment Refusal; D014463:Ultrasonography; D014692:Ventilation-Perfusion Ratio
chemical_list: D019275:Radiopharmaceuticals; C056708:Technegas; D013670:Sodium Pertechnetate Tc 99m