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Ultrasound Before CTA To Check For Clot?

January 19, 2011
Written by: , Filed in: Chest Radiology, Diagnostic Imaging, Emergency Radiology
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A new imaging strategy for diagnosing possible cases of pulmonary embolism (PE) in the emergency department could both increase patient life expectancy and significantly reduce costs, according to a study led by a University of Cincinnati researcher.

The most common test for PE (in which a blood clot, usually from the legs, travels to the lungs and lodges in a pulmonary artery, often with fatal results) involves CT angiography—injecting contrast dye into a vein, then imaging blood vessels with a CT scan.

“The use of CTA for blood clots has increased 235 percent between 1991 and 2002,” said Michael Ward, MD, MBA, an emergency medicine operations research fellow at the university. “However, recent literature has shown there are significant risks associated with CTA, including radiation, severe allergic reaction, and kidney failure from the contrast dye.”

He was quoted in a university news release.

Seeking an alternative, Dr. Ward led a study in June 2010 using existing published data and computer modeling to predict costs and results for two approaches to PE diagnosis. The approaches were: test all patients using CTA, or first use compression ultrasound to test all patients for deep vein thrombosis (DVT)—the formation of a blood clot in the leg.

“The diagnosis of a DVT, together with symptoms of PE, almost certainly suggests a PE,” said Dr. Ward. “If the test for DVT was positive, the patient was admitted to the hospital for PE and started treatment with anticoagulants. If the test was negative, patients had a CTA performed to evaluate for PE.”

Such a strategy has been used before, but only as a rule-out tool rather than, as in his approach, a rule-in tool, Dr. Ward said. The study was published online last week in Academic Emergency Medicine.

The study projected that, compared with using CTA for everyone, a protocol of trying compression ultrasound first would cost an average of $1,457.70 less per patient and would result in an average gain of 0.0213 “quality-adjusted life-years.” Said Dr. Ward:

Our work suggests that a PE diagnostic strategy that uses compression ultrasound followed by selective CTA is not only cost-effective, but may be a way to reduce the incidence of adverse effects associated with the CTA.

Related seminar: Thoracic Imaging

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