title: CT pulmonary angiography: increasingly diagnosing less severe pulmonary emboli.
abstract: BACKGROUND
  It is unknown whether the observed increase in computed tomography pulmonary angiography (CTPA) utilization has resulted in increased detection of pulmonary emboli (PEs) with a less severe disease spectrum.
  
  
  METHODS
  Trends in utilization, diagnostic yield, and disease severity were evaluated for 4,048 consecutive initial CTPAs performed in adult patients in the emergency department of a large urban academic medical center between 1/1/2004 and 10/31/2009. Transthoracic echocardiography (TTE) findings and peak serum troponin levels were evaluated to assess for the presence of PE-associated right ventricular (RV) abnormalities (dysfunction or dilatation) and myocardial injury, respectively. Statistical analyses were performed using multivariate logistic regression.
  
  
  RESULTS
  268 CTPAs (6.6%) were positive for acute PE, and 3,780 (93.4%) demonstrated either no PE or chronic PE. There was a significant increase in the likelihood of undergoing CTPA per year during the study period (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.04-1.07, P<0.01). There was no significant change in the likelihood of having a CTPA diagnostic of an acute PE per year (OR 1.03, 95% CI 0.95-1.11, P = 0.49). The likelihood of diagnosing a less severe PE on CTPA with no associated RV abnormalities or myocardial injury increased per year during the study period (OR 1.39, 95% CI 1.10-1.75, P = 0.01).
  
  
  CONCLUSIONS
  CTPA utilization has risen with no corresponding change in diagnostic yield, resulting in an increase in PE detection. There is a concurrent rise in the likelihood of diagnosing a less clinically severe spectrum of PEs.
authors.affiliation: Department of Medicine, Columbia University Medical Center and NewYork-Presbyterian Hospital, New York, New York, United States of America.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schissler
authors.forename: Anna
authors.initials: A
authors.lastname: Rozenshtein
authors.forename: Michal E
authors.initials: ME
authors.lastname: Kulon
authors.forename: Gregory D N
authors.initials: GD
authors.lastname: Pearson
authors.forename: Robert A
authors.initials: RA
authors.lastname: Green
authors.forename: Peter D
authors.initials: PD
authors.lastname: Stetson
authors.forename: David J
authors.initials: DJ
authors.lastname: Brenner
authors.forename: Belinda
authors.initials: B
authors.lastname: D'Souza
authors.forename: Wei-Yann
authors.initials: WY
authors.lastname: Tsai
authors.forename: Neil W
authors.initials: NW
authors.lastname: Schluger
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Einstein
mesh_terms: D000328:Adult; D000792:Angiography / Q000379:methods* / Q000706:statistics & numerical data; D004452:Echocardiography / Q000379:methods; D006801:Humans; D061330:Multidetector Computed Tomography / Q000379:methods* / Q000706:statistics & numerical data; D009518:New York; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis*; D014336:Troponin / Q000097:blood; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology
chemical_list: D014336:Troponin