We have located links that may give you full text access.
Changing practice patterns in the workup of pulmonary embolism.
Chest 1995 April
STUDY OBJECTIVE: While the "gold standard" for diagnosis of pulmonary embolism remains selective pulmonary angiography and its sensitivity and specificity are very high, it is not frequently used. The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) clinical trial results confirmed the low mortality and morbidity of pulmonary angiogram and the need for further evaluation of patients with "low" and "intermediate" probability ventilation/perfusion scans. We wanted to determine whether physician behavior changed from 1988 to 1991.
DESIGN: Retrospective review of inpatients having a ventilation/perfusion scan for suspected pulmonary embolism. The official reading of the ventilation/perfusion scans, venous leg sonograms with Doppler, contrast leg venograms, and pulmonary angiograms were recorded as well as the final diagnosis and treatment.
SETTING: A large city hospital--The New York Hospital-Cornell Medical Center, New York.
PATIENTS: All inpatients who had a ventilation perfusion scan in 1988 and all inpatients who had the procedure in 1991.
INTERVENTION: None.
RESULTS: The percentages of patients in each ventilation/perfusion scan category were similar in 1988 and 1991 as was the percentage of those who underwent anticoagulation therapy. Significantly more sonograms, however, were performed in 1991 along with fewer angiograms and venograms without any significant change in the overall cost.
CONCLUSIONS: In 1991, additional diagnostic tests were performed after a low or intermediate ventilation/perfusion scan, but the percentage of patients who underwent anticoagulation did not change from 1988. This suggests that better diagnostic screening approaches with more explicit guidelines need to be developed that take into account the local disease prevalence and hospital diagnostic and practice patterns.
DESIGN: Retrospective review of inpatients having a ventilation/perfusion scan for suspected pulmonary embolism. The official reading of the ventilation/perfusion scans, venous leg sonograms with Doppler, contrast leg venograms, and pulmonary angiograms were recorded as well as the final diagnosis and treatment.
SETTING: A large city hospital--The New York Hospital-Cornell Medical Center, New York.
PATIENTS: All inpatients who had a ventilation perfusion scan in 1988 and all inpatients who had the procedure in 1991.
INTERVENTION: None.
RESULTS: The percentages of patients in each ventilation/perfusion scan category were similar in 1988 and 1991 as was the percentage of those who underwent anticoagulation therapy. Significantly more sonograms, however, were performed in 1991 along with fewer angiograms and venograms without any significant change in the overall cost.
CONCLUSIONS: In 1991, additional diagnostic tests were performed after a low or intermediate ventilation/perfusion scan, but the percentage of patients who underwent anticoagulation did not change from 1988. This suggests that better diagnostic screening approaches with more explicit guidelines need to be developed that take into account the local disease prevalence and hospital diagnostic and practice patterns.
Full text links
Related Resources
Trending Papers
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection.International Journal of Molecular Sciences 2024 April 4
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
A Guide to the Use of Vasopressors and Inotropes for Patients in Shock.Journal of Intensive Care Medicine 2024 April 14
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app