Leijstra, M.A. (2012) De diagnostische opbrengst van CT-thorax angiografie bij verdenking longembolie, aangevraagd door verschillende specialismen : Vaststellen van onafhankelijke voorspellers voor de diagnostische opbrengst van CTPA. thesis, Medicine.
Full text available on request.Abstract
Introduction: In the Isala klinieken, a lot of CT-scans are made with the suspicion of pulmonary embolism every year. This life threatening disease requires a quick and reliable diagnosis in order to start treatment timely. There is, however a chance over diagnosis, which might lead to unnecessary exposure to radiation, particularly when patients are not assessed on clinical probability properly prior to ordering diagnostic imaging. In assessing the clinical probability the Wells-score and D-dimer value are of great importance. The diagnosis is in most cases confirmed or rejected by performing a CT of the pulmonary arteries (CTPA). The aim of this study is to determine the diagnostic yield of CTPA in our centre and it intends to identify factors associated with the diagnostic yield of CTPA. Differences between specialities as well as adherence to protocol will be assessed. Methods: All patients in our centre who received a first CTPA with the suspicion of pulmonary embolism in 2010 were included in this study. Of 974, mainly outpatient, subjects CTPA results with respect to the diagnosis of pulmonary embolism were determined, as well as other relevant clinical information. Logistic regression analysis was used to identify factors that were associated with the diagnostic yield of CTPA. Results: The diagnostic yield of CTPA in this study was 23% and ranged from 19,5% to 23,9% between the different specialities. Differences in the diagnostic yield of CTPA between specialities and between the two emergency departments were not significant. The Wells-score was reported for 127 of the 974 included patients (13%) and the D-dimer level was reported in 601 of the patients (61,6%). For 34 of the 58 patients who had a high Wells-score a D-dimerlevel was also determined (58,6%). The small number of Wells-scores made interpretation of some of the analysis difficult. The following factors were found do independently increase the diagnostic yield of CTPA: increasing age, male sex, chest pain, dyspnea, atelectasis/consolidation on CT and/or finding an intrapulmonary process on CT. Factors that were associated with a reduction of diagnostic yield of CTPA were: female sex, cough, a cardiac history, Chronic obstructive pulmonary disease (COPD) and/or interstitial pulmonary disease on CT evaluation. Conclusion: This study shows that the diagnostics regarding pulmonary embolism in the Isala klinieken is of good quality in comparison with findings in the available literature. There is, however, room for improvement in adherence to protocol. Some independent predictors of CTPA for pulmonary embolism were found, that could be used in clinical decision making. A better model for clinical probability assessment of pulmonary embolism could improve the diagnostic yield of CTPA and reduce costs. Further prospective studies are required to confirm the factors associated with the diagnostic yield of CTPA for pulmonary embolism found in this study.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Berg, . J.W.K. van den (longarts) and Medebegeleiders: and Boomsma drs. M.F. (radioloog) and Uil drs. S.M.(gezondheidswetenschapper) and Locatie: Isala klinieken Zwolle, locatie Weezenlanden. Afdel |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:07 |
| Last Modified: | 25 Jun 2020 11:07 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2656 |
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