Can We Rely on Computed Tomographic Scanning to Diagnose Pulmonary Embolism in Critically III Surgical Patients?

George C. Velmahos, Konstantinos G. Toutouzas, Pantelis Vassiliu, Peter Rhee, Alison Wilcox, Sue Ellen Hanks, Linda S. Chan, Areti Tillou, Demetrios Demetriades, John T Owings, Matthew J. Wall, Joseph M. Van De Water, Raul Coimbra, John A. Weigelt

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Spiral computed tomographic pulmonary angiography (CTPA) is gaining an increasing role in pulmonary embolism (PE) diagnosis because it is more convenient and less invasive than conventional pulmonary angiography (PA). Encouraging reports on the reliability of CTPA for medical patients have prompted widespread use despite the fact that its value in critically ill surgical patients has been inadequately explored. Hemodynamic and respiratory issues of critical illness may interfere with CTPA's diagnostic accuracy. The objective of this study was to compare CTPA with PA for the diagnosis of PE in critically ill surgical patients. Methods: Over 30 months (August 1999-February 2002), 37 critically ill surgical patients (28 trauma and 9 non-trauma patients) with clinical suspicion of PE were enrolled prospectively. CTPA and PA were independently interpreted by four radiologists (two for each test) blinded to each other's interpretation. Clinical suspicion for PE was classified as high, intermediate, or low on the basis of predetermined criteria. PA was considered as the standard of reference for the diagnosis of PE. Results: PE was found in 15 (40%) patients by PA: central PE in 8 and peripheral PE in 7. CTPA and PA findings were different in 11 patients (30%): CTPA was false-negative in 9 patients and false-positive in 2. Its sensitivity and specificity were PE 50% and 100%, respectively, for central PE; 28% and 93% for peripheral PE; and 40% and 91% for all PE. There were no differences in risk factors or clinical characteristics between patients with and without PE. The level of clinical suspicion was identical in the two groups. The independent reviewers disagreed on CTPA or PA interpretations in 11% and 16% of the readings, respectively. Conclusion: PA remains the "gold standard" for diagnosis of PE in critically ill surgical patients. CTPA should be explored further before being universally accepted. Clinical criteria are unreliable for detecting PE in this population and therefore a high index of suspicion should be maintained.

Original languageEnglish (US)
Pages (from-to)518-526
Number of pages9
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume56
Issue number3
StatePublished - Mar 2004

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Pulmonary Embolism
Angiography
Lung
Critical Illness
Reading

Keywords

  • Computed tomography
  • Pulmonary angiography
  • Pulmonary embolism
  • Sensitivity
  • Specificity

ASJC Scopus subject areas

  • Surgery

Cite this

Velmahos, G. C., Toutouzas, K. G., Vassiliu, P., Rhee, P., Wilcox, A., Hanks, S. E., ... Weigelt, J. A. (2004). Can We Rely on Computed Tomographic Scanning to Diagnose Pulmonary Embolism in Critically III Surgical Patients? Journal of Trauma - Injury, Infection and Critical Care, 56(3), 518-526.

Can We Rely on Computed Tomographic Scanning to Diagnose Pulmonary Embolism in Critically III Surgical Patients? / Velmahos, George C.; Toutouzas, Konstantinos G.; Vassiliu, Pantelis; Rhee, Peter; Wilcox, Alison; Hanks, Sue Ellen; Chan, Linda S.; Tillou, Areti; Demetriades, Demetrios; Owings, John T; Wall, Matthew J.; Van De Water, Joseph M.; Coimbra, Raul; Weigelt, John A.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 56, No. 3, 03.2004, p. 518-526.

Research output: Contribution to journalArticle

Velmahos, GC, Toutouzas, KG, Vassiliu, P, Rhee, P, Wilcox, A, Hanks, SE, Chan, LS, Tillou, A, Demetriades, D, Owings, JT, Wall, MJ, Van De Water, JM, Coimbra, R & Weigelt, JA 2004, 'Can We Rely on Computed Tomographic Scanning to Diagnose Pulmonary Embolism in Critically III Surgical Patients?', Journal of Trauma - Injury, Infection and Critical Care, vol. 56, no. 3, pp. 518-526.
Velmahos, George C. ; Toutouzas, Konstantinos G. ; Vassiliu, Pantelis ; Rhee, Peter ; Wilcox, Alison ; Hanks, Sue Ellen ; Chan, Linda S. ; Tillou, Areti ; Demetriades, Demetrios ; Owings, John T ; Wall, Matthew J. ; Van De Water, Joseph M. ; Coimbra, Raul ; Weigelt, John A. / Can We Rely on Computed Tomographic Scanning to Diagnose Pulmonary Embolism in Critically III Surgical Patients?. In: Journal of Trauma - Injury, Infection and Critical Care. 2004 ; Vol. 56, No. 3. pp. 518-526.
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title = "Can We Rely on Computed Tomographic Scanning to Diagnose Pulmonary Embolism in Critically III Surgical Patients?",
abstract = "Background: Spiral computed tomographic pulmonary angiography (CTPA) is gaining an increasing role in pulmonary embolism (PE) diagnosis because it is more convenient and less invasive than conventional pulmonary angiography (PA). Encouraging reports on the reliability of CTPA for medical patients have prompted widespread use despite the fact that its value in critically ill surgical patients has been inadequately explored. Hemodynamic and respiratory issues of critical illness may interfere with CTPA's diagnostic accuracy. The objective of this study was to compare CTPA with PA for the diagnosis of PE in critically ill surgical patients. Methods: Over 30 months (August 1999-February 2002), 37 critically ill surgical patients (28 trauma and 9 non-trauma patients) with clinical suspicion of PE were enrolled prospectively. CTPA and PA were independently interpreted by four radiologists (two for each test) blinded to each other's interpretation. Clinical suspicion for PE was classified as high, intermediate, or low on the basis of predetermined criteria. PA was considered as the standard of reference for the diagnosis of PE. Results: PE was found in 15 (40{\%}) patients by PA: central PE in 8 and peripheral PE in 7. CTPA and PA findings were different in 11 patients (30{\%}): CTPA was false-negative in 9 patients and false-positive in 2. Its sensitivity and specificity were PE 50{\%} and 100{\%}, respectively, for central PE; 28{\%} and 93{\%} for peripheral PE; and 40{\%} and 91{\%} for all PE. There were no differences in risk factors or clinical characteristics between patients with and without PE. The level of clinical suspicion was identical in the two groups. The independent reviewers disagreed on CTPA or PA interpretations in 11{\%} and 16{\%} of the readings, respectively. Conclusion: PA remains the {"}gold standard{"} for diagnosis of PE in critically ill surgical patients. CTPA should be explored further before being universally accepted. Clinical criteria are unreliable for detecting PE in this population and therefore a high index of suspicion should be maintained.",
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AU - Velmahos, George C.

AU - Toutouzas, Konstantinos G.

AU - Vassiliu, Pantelis

AU - Rhee, Peter

AU - Wilcox, Alison

AU - Hanks, Sue Ellen

AU - Chan, Linda S.

AU - Tillou, Areti

AU - Demetriades, Demetrios

AU - Owings, John T

AU - Wall, Matthew J.

AU - Van De Water, Joseph M.

AU - Coimbra, Raul

AU - Weigelt, John A.

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N2 - Background: Spiral computed tomographic pulmonary angiography (CTPA) is gaining an increasing role in pulmonary embolism (PE) diagnosis because it is more convenient and less invasive than conventional pulmonary angiography (PA). Encouraging reports on the reliability of CTPA for medical patients have prompted widespread use despite the fact that its value in critically ill surgical patients has been inadequately explored. Hemodynamic and respiratory issues of critical illness may interfere with CTPA's diagnostic accuracy. The objective of this study was to compare CTPA with PA for the diagnosis of PE in critically ill surgical patients. Methods: Over 30 months (August 1999-February 2002), 37 critically ill surgical patients (28 trauma and 9 non-trauma patients) with clinical suspicion of PE were enrolled prospectively. CTPA and PA were independently interpreted by four radiologists (two for each test) blinded to each other's interpretation. Clinical suspicion for PE was classified as high, intermediate, or low on the basis of predetermined criteria. PA was considered as the standard of reference for the diagnosis of PE. Results: PE was found in 15 (40%) patients by PA: central PE in 8 and peripheral PE in 7. CTPA and PA findings were different in 11 patients (30%): CTPA was false-negative in 9 patients and false-positive in 2. Its sensitivity and specificity were PE 50% and 100%, respectively, for central PE; 28% and 93% for peripheral PE; and 40% and 91% for all PE. There were no differences in risk factors or clinical characteristics between patients with and without PE. The level of clinical suspicion was identical in the two groups. The independent reviewers disagreed on CTPA or PA interpretations in 11% and 16% of the readings, respectively. Conclusion: PA remains the "gold standard" for diagnosis of PE in critically ill surgical patients. CTPA should be explored further before being universally accepted. Clinical criteria are unreliable for detecting PE in this population and therefore a high index of suspicion should be maintained.

AB - Background: Spiral computed tomographic pulmonary angiography (CTPA) is gaining an increasing role in pulmonary embolism (PE) diagnosis because it is more convenient and less invasive than conventional pulmonary angiography (PA). Encouraging reports on the reliability of CTPA for medical patients have prompted widespread use despite the fact that its value in critically ill surgical patients has been inadequately explored. Hemodynamic and respiratory issues of critical illness may interfere with CTPA's diagnostic accuracy. The objective of this study was to compare CTPA with PA for the diagnosis of PE in critically ill surgical patients. Methods: Over 30 months (August 1999-February 2002), 37 critically ill surgical patients (28 trauma and 9 non-trauma patients) with clinical suspicion of PE were enrolled prospectively. CTPA and PA were independently interpreted by four radiologists (two for each test) blinded to each other's interpretation. Clinical suspicion for PE was classified as high, intermediate, or low on the basis of predetermined criteria. PA was considered as the standard of reference for the diagnosis of PE. Results: PE was found in 15 (40%) patients by PA: central PE in 8 and peripheral PE in 7. CTPA and PA findings were different in 11 patients (30%): CTPA was false-negative in 9 patients and false-positive in 2. Its sensitivity and specificity were PE 50% and 100%, respectively, for central PE; 28% and 93% for peripheral PE; and 40% and 91% for all PE. There were no differences in risk factors or clinical characteristics between patients with and without PE. The level of clinical suspicion was identical in the two groups. The independent reviewers disagreed on CTPA or PA interpretations in 11% and 16% of the readings, respectively. Conclusion: PA remains the "gold standard" for diagnosis of PE in critically ill surgical patients. CTPA should be explored further before being universally accepted. Clinical criteria are unreliable for detecting PE in this population and therefore a high index of suspicion should be maintained.

KW - Computed tomography

KW - Pulmonary angiography

KW - Pulmonary embolism

KW - Sensitivity

KW - Specificity

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