Changing trends in venous thromboembolism-related imaging in Western Australian teaching hospitals, 2002-2010.
OBJECTIVE
To determine trends in referral for venous thromboembolism (VTE) imaging in Western Australian teaching hospitals.


METHODS
Retrospective audit of the WA picture archiving and communication system, PathWest Laboratory Medicine records, the hospital morbidity database at the four adult teaching hospitals in Perth, WA, and the WA death registry.


METHODS
All patients referred for VTE-related imaging, and all hospital separations for pulmonary embolism (PE) during 2002-2010.


METHODS
Number of referrals for computed tomography pulmonary angiography (CTPA), ventilation-perfusion lung scintigraphy, leg ultrasound and plasma D-dimer assay; hospital separations for PE and deaths from PE.


RESULTS
Referrals for VTE-related imaging increased by 34%, while PE-related imaging increased by 65% during the study period, owing entirely to referrals for CTPA, which increased by more than 500%. The number of hospital separations for PE increased by 45% over the same period and the prevalence of PE among referred patients fell from 22.1% in 2002 to 19.5% in 2010. There was no fall in the death rate from PE in WA during the study period (P = 0.19). The number of D-dimer tests performed in the same hospitals increased by 42% over the study period.


CONCLUSIONS
The increased number of referrals for PE-related imaging resulted in more diagnoses but no reduction in deaths from PE in WA. Widespread D-dimer testing did not reduce referrals for imaging and is likely to have resulted in increased referrals. Increased imaging leads to overdiagnosis of clinically insignificant PE, and alternative strategies are required to reduce PE death rates.
Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Tatiana
T
Segard
William B G
WB
Macdonald
D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006784:Hospitals, Teaching / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D016014:Linear Models; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging; D015995:Prevalence; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000401:mortality; D014904:Western Australia / Q000453:epidemiology
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D