Pulmonary Embolism Diagnosis Mostly in Line With Guidelines

Study finds some variation in imaging tests by physician specialty and geographic location
By Jeff Muise
HealthDay Reporter

MONDAY, March 29 (HealthDay News) -- Diagnostic imaging tests used for suspected pulmonary embolism are generally in accordance with accepted guidelines, but there is some variation by treating physician specialty and geographic location, according to research published in the April American Journal of Roentgenology.

Mythreyi Bhargavan, Ph.D., of Johns Hopkins University in Baltimore, and colleagues screened a sample of 2005 Medicare beneficiaries for emergency room visits or hospital admissions for pulmonary embolism or its symptoms, such as chest pain, shortness of breath, and fainting. To ascertain conformance to recommended diagnostic guidelines, the researchers analyzed variations in diagnostic imaging tests used and their associations with site of care, geographic location, physician specialty, and patient characteristics.

For patients suspected of having a pulmonary embolism, echocardiography was used in 26 percent of patients, making it the most common imaging test used, the authors note. Computed tomography (CT) of the chest or CT angiography was used in 11 percent of patients, duplex ultrasound in 7.3 percent, and cardiac perfusion study in 6.9 percent. Among patients admitted for the condition, the researchers found that the most common imaging tests were chest CT or CT angiography (49 percent), duplex ultrasound (18 percent), echocardiography (10.9 percent), and ventilation-perfusion scintigraphy (10.9 percent). When pulmonary embolism was suspected, there was substantial practice variation among physician specialties and geographic locations. However, for patients admitted with a pulmonary embolism diagnosis, there were fewer variations.

"Physician practice in the diagnosis of pulmonary embolism is broadly consistent with recommendations. However, variations by physician specialty and geographic location may be evidence of inappropriate imaging," the authors write.

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