Withholding anticoagulation after a negative computed tomography pulmonary angiogram as a stand-alone imaging investigation: A prospective management study

R. M. Subramaniam, D. Blair, K. Gilbert, G. Coltman, J. Sleigh, N. Karalus

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Accurate diagnosis of pulmonary embolism (PE) is essential and it is not clear whether a computed tomography pulmonary angiogram (CTPA) could be used as a stand-alone imaging investigation. The aim of the study was to test the accuracy of the clinical outcome of a negative CTPA as a stand-alone imaging investigation to exclude PE. Methods: Five hundred and thirty-four consecutive patients who had a CTPA for diagnosis or exclusion of PE were recruited from March 2003 to October 2004. Four hundred and ninety-four patients had a helical CTPA as a stand-alone imaging investigation for diagnosis or exclusion of PE. A 3-month post-CTPA follow up was carried out in all patients to establish the clinical outcome accuracy of a negative CTPA as a stand-alone imaging investigation. Results: There were 387 (78.3%) negative and 107 (21.7%) positive CTPA examinations. The average age of the patients was 57.16 years (standard deviation 18.57). Among those with a negative CTPA who survived, one patient had deep vein thrombosis and 342 patients had no evidence of an episode of venous thromboembolism or PE at the 3-month follow up. Thirty-eight patients died within the 3-month follow-up period and one patient's death was attributed to suspected PE. The negative predictive value of a CTPA is 99.5% (95% confidence interval 98.1-99.9%). Conclusion: Helical negative CTPA examination excludes clinically significant PE as a stand-alone imaging investigation. Where concurrent deep vein thrombosis is suspected, lower limb needs to be imaged by ultrasound if the CTPA is negative.

Original languageEnglish (US)
Pages (from-to)624-630
Number of pages7
JournalInternal Medicine Journal
Volume37
Issue number9
DOIs
StatePublished - Sep 1 2007

Fingerprint

Angiography
Tomography
Prospective Studies
Pulmonary Embolism
Lung
Spiral Computed Tomography
Venous Thrombosis
Venous Thromboembolism
Lower Extremity
Confidence Intervals

Keywords

  • Computed tomography
  • Pulmonary embolism
  • Ultrasound

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Withholding anticoagulation after a negative computed tomography pulmonary angiogram as a stand-alone imaging investigation : A prospective management study. / Subramaniam, R. M.; Blair, D.; Gilbert, K.; Coltman, G.; Sleigh, J.; Karalus, N.

In: Internal Medicine Journal, Vol. 37, No. 9, 01.09.2007, p. 624-630.

Research output: Contribution to journalArticle

@article{40430e6a87564f5ca58ea333c62a9af7,
title = "Withholding anticoagulation after a negative computed tomography pulmonary angiogram as a stand-alone imaging investigation: A prospective management study",
abstract = "Background: Accurate diagnosis of pulmonary embolism (PE) is essential and it is not clear whether a computed tomography pulmonary angiogram (CTPA) could be used as a stand-alone imaging investigation. The aim of the study was to test the accuracy of the clinical outcome of a negative CTPA as a stand-alone imaging investigation to exclude PE. Methods: Five hundred and thirty-four consecutive patients who had a CTPA for diagnosis or exclusion of PE were recruited from March 2003 to October 2004. Four hundred and ninety-four patients had a helical CTPA as a stand-alone imaging investigation for diagnosis or exclusion of PE. A 3-month post-CTPA follow up was carried out in all patients to establish the clinical outcome accuracy of a negative CTPA as a stand-alone imaging investigation. Results: There were 387 (78.3{\%}) negative and 107 (21.7{\%}) positive CTPA examinations. The average age of the patients was 57.16 years (standard deviation 18.57). Among those with a negative CTPA who survived, one patient had deep vein thrombosis and 342 patients had no evidence of an episode of venous thromboembolism or PE at the 3-month follow up. Thirty-eight patients died within the 3-month follow-up period and one patient's death was attributed to suspected PE. The negative predictive value of a CTPA is 99.5{\%} (95{\%} confidence interval 98.1-99.9{\%}). Conclusion: Helical negative CTPA examination excludes clinically significant PE as a stand-alone imaging investigation. Where concurrent deep vein thrombosis is suspected, lower limb needs to be imaged by ultrasound if the CTPA is negative.",
keywords = "Computed tomography, Pulmonary embolism, Ultrasound",
author = "Subramaniam, {R. M.} and D. Blair and K. Gilbert and G. Coltman and J. Sleigh and N. Karalus",
year = "2007",
month = "9",
day = "1",
doi = "10.1111/j.1445-5994.2007.01387.x",
language = "English (US)",
volume = "37",
pages = "624--630",
journal = "Internal Medicine Journal",
issn = "1444-0903",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - Withholding anticoagulation after a negative computed tomography pulmonary angiogram as a stand-alone imaging investigation

T2 - A prospective management study

AU - Subramaniam, R. M.

AU - Blair, D.

AU - Gilbert, K.

AU - Coltman, G.

AU - Sleigh, J.

AU - Karalus, N.

PY - 2007/9/1

Y1 - 2007/9/1

N2 - Background: Accurate diagnosis of pulmonary embolism (PE) is essential and it is not clear whether a computed tomography pulmonary angiogram (CTPA) could be used as a stand-alone imaging investigation. The aim of the study was to test the accuracy of the clinical outcome of a negative CTPA as a stand-alone imaging investigation to exclude PE. Methods: Five hundred and thirty-four consecutive patients who had a CTPA for diagnosis or exclusion of PE were recruited from March 2003 to October 2004. Four hundred and ninety-four patients had a helical CTPA as a stand-alone imaging investigation for diagnosis or exclusion of PE. A 3-month post-CTPA follow up was carried out in all patients to establish the clinical outcome accuracy of a negative CTPA as a stand-alone imaging investigation. Results: There were 387 (78.3%) negative and 107 (21.7%) positive CTPA examinations. The average age of the patients was 57.16 years (standard deviation 18.57). Among those with a negative CTPA who survived, one patient had deep vein thrombosis and 342 patients had no evidence of an episode of venous thromboembolism or PE at the 3-month follow up. Thirty-eight patients died within the 3-month follow-up period and one patient's death was attributed to suspected PE. The negative predictive value of a CTPA is 99.5% (95% confidence interval 98.1-99.9%). Conclusion: Helical negative CTPA examination excludes clinically significant PE as a stand-alone imaging investigation. Where concurrent deep vein thrombosis is suspected, lower limb needs to be imaged by ultrasound if the CTPA is negative.

AB - Background: Accurate diagnosis of pulmonary embolism (PE) is essential and it is not clear whether a computed tomography pulmonary angiogram (CTPA) could be used as a stand-alone imaging investigation. The aim of the study was to test the accuracy of the clinical outcome of a negative CTPA as a stand-alone imaging investigation to exclude PE. Methods: Five hundred and thirty-four consecutive patients who had a CTPA for diagnosis or exclusion of PE were recruited from March 2003 to October 2004. Four hundred and ninety-four patients had a helical CTPA as a stand-alone imaging investigation for diagnosis or exclusion of PE. A 3-month post-CTPA follow up was carried out in all patients to establish the clinical outcome accuracy of a negative CTPA as a stand-alone imaging investigation. Results: There were 387 (78.3%) negative and 107 (21.7%) positive CTPA examinations. The average age of the patients was 57.16 years (standard deviation 18.57). Among those with a negative CTPA who survived, one patient had deep vein thrombosis and 342 patients had no evidence of an episode of venous thromboembolism or PE at the 3-month follow up. Thirty-eight patients died within the 3-month follow-up period and one patient's death was attributed to suspected PE. The negative predictive value of a CTPA is 99.5% (95% confidence interval 98.1-99.9%). Conclusion: Helical negative CTPA examination excludes clinically significant PE as a stand-alone imaging investigation. Where concurrent deep vein thrombosis is suspected, lower limb needs to be imaged by ultrasound if the CTPA is negative.

KW - Computed tomography

KW - Pulmonary embolism

KW - Ultrasound

UR - http://www.scopus.com/inward/record.url?scp=34547909219&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34547909219&partnerID=8YFLogxK

U2 - 10.1111/j.1445-5994.2007.01387.x

DO - 10.1111/j.1445-5994.2007.01387.x

M3 - Article

C2 - 17543006

AN - SCOPUS:34547909219

VL - 37

SP - 624

EP - 630

JO - Internal Medicine Journal

JF - Internal Medicine Journal

SN - 1444-0903

IS - 9

ER -