Safety of multidetector computed tomography pulmonary angiography to exclude pulmonary embolism in patients with a likely pretest clinical probability

• Published in: Journal of thrombosis and haemostasis Vol. 15; no. 8; pp. 1584 - 1590
• Main Authors: Robert‐Ebadi, H., Glauser, F., Planquette, B., Moumneh, T., Le Gal, G., Righini, M.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.08.2017; Wiley
• Subjects: Aged; Algorithms; Ambulatory Care; Angiography; Cardiology and cardiovascular system; clinical prediction rule; Computed tomography; Computed Tomography Angiography - adverse effects; Computed Tomography Angiography - methods; diagnosis; Embolism; Embolisms; Europe; Female; Human health and pathology; Humans; Life Sciences; Male; Medical imaging; Middle Aged; multidetector computed tomography; Multidetector Computed Tomography - adverse effects; Multidetector Computed Tomography - methods; Patient Safety; Predictive Value of Tests; Prognosis; Pulmonary arteries; Pulmonary Artery - diagnostic imaging; pulmonary embolism; Pulmonary Embolism - diagnostic imaging; Pulmonary embolisms; Radiation Dosage; Radiation Exposure - adverse effects; Reproducibility of Results; Retrospective Studies; Risk Assessment; Risk Factors; spiral computed tomography; Thromboembolism; Time Factors; Tomography; Venous Thromboembolism - diagnostic imaging; diagnosis; spiral computed tomography; pulmonary embolism; clinical prediction rule; multidetector computed tomography
• ISSN: 1538-7933; 1538-7836; 1538-7836
• DOI: 10.1111/jth.13746

Essentials Safety of computed tomography (CTPA) to exclude pulmonary embolism (PE) in all patients is debated. We analysed the outcome of PE‐likely outpatients left untreated after negative CTPA alone. The 3‐month venous thromboembolic risk in these patients was very low (0.6%; 95% CI 0.2–2.3). Multidetector CTPA alone safely excludes PE in patients with likely clinical probability. Summary Background In patients with suspected pulmonary embolism (PE) classified as having a likely or high pretest clinical probability, the need to perform additional testing after a negative multidetector computed tomography pulmonary angiography (CTPA) finding remains a matter of debate. Objectives To assess the safety of excluding PE by CTPA without additional imaging in patients with a likely pretest probability of PE. Patients/Methods We retrospectively analyzed patients included in two multicenter management outcome studies that assessed diagnostic algorithms for PE diagnosis. Results Two thousand five hundred and twenty‐two outpatients with suspected PE were available for analysis. Of these 2522 patients, 845 had a likely clinical probability as assessed by use of the simplified revised Geneva score. Of all of these patients, 314 had the diagnosis of PE excluded by a negative CTPA finding alone without additional testing, and were left without anticoagulant treatment and followed up for 3 months. Two patients presented with a venous thromboembolism (VTE) during follow‐up. Therefore, the 3‐month VTE risk in likely‐probability patients after a negative CTPA finding alone was 2/314 (0.6%; 95% confidence interval [CI] 0.2–2.3%). Conclusions In outpatients with suspected PE and a likely clinical probability as assessed by use of the simplified revised Geneva score, CTPA alone seems to be able to safely exclude PE, with a low 3‐month VTE rate, which is similar to the VTE rate following the gold standard, i.e. pulmonary angiography.