title: Treatment of single peripheral pulmonary emboli: patient outcomes and factors associated with decision to treat.
abstract: BACKGROUND
  Increasing use of computed tomography pulmonary angiography together with higher-resolution scanners has increased the detection of peripheral filling defects. Physicians face the dilemma of whether to treat patients with these findings, especially single defects. The aims of this study were to compare the outcomes of treated and untreated patients with single peripheral filling defects (SPFD) and identify factors associated with treatment.
  
  
  METHODS
  All cases with SPFDs over 66 months in a single institution were identified. Patient and treatment information were abstracted and data on 90-day mortality and postdischarge venous thromboembolism (VTE) were collected.
  
  
  RESULTS
  A total of 4906 computed tomography pulmonary angiograms were reviewed. A SPFD was identified in 3.1% (n = 153). Of the 153 patients, 134 met criteria for study inclusion. In 99 of 134 (73.9%) studies, the defect was called a pulmonary embolus (PE) by the initial radiologist. Treatment was administered to 61 of 134 (45.5%) patients; 5 patients died in each group. Postdischarge VTE occurred in 3 treated and 2 untreated patients. In 52 of 153 cases, an additional study was performed. None of the patients with normal ventilation perfusion scan and compression ultrasound received treatment. Immobility (odds ratio [OR]: 3.90, 95% confidence interval [CI]: 1.45-10.60), previous VTE (OR: 3.72, 95% CI: 1.18-11.70), and determination of PE by the radiologist (OR: 24.68, 95% CI: 5.40-112.90) were associated with treatment.
  
  
  CONCLUSIONS
  There was no difference in 90-day mortality or recurrence between treated and untreated patients. The most influential factor associated with treatment was the radiologist's interpretation. When secondary lung imaging studies were negative, no patient received treatment.
authors: Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut; Department of Internal Medicine, Norwalk Hospital, Norwalk, Connecticut.
authors: O'Neil
authors: O
authors: Green
authors: Jason
authors: J
authors: Lempel
authors: Andrew
authors: A
authors: Kolodziej
authors: Rabinder
authors: R
authors: Sandhu
authors: Daniel
authors: D
authors: Castro-Pereira
authors: Yun
authors: Y
authors: Wang
authors: Ronald
authors: R
authors: Lee
authors: Jonathan M
authors: JM
authors: Fine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D020000:Decision Support Systems, Clinical / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000639:trends; D016896:Treatment Outcome