The actual role of CT and ventilation-perfusion scanning in workup for suspected pulmonary embolism: evidence from hospitals.

摘要

OBJECTIVE: Over the past two decades, CT has been found valuable in the diagnosis of pulmonary embolism (PE). We sought to ascertain the relative roles of CT and ventilation-perfusion (V/Q) scanning, the previously preferred technique, in the diagnosis of PE in recent practice and whether there is variation among hospital types. MATERIALS AND METHODS: Using the Medicare anonymized 5% of beneficiaries complete claims file for 2005, we studied the use of relevant CT and V/Q scanning in the evaluation of patients with a diagnosis of PE and of patients with symptoms that might have been due to PE (chest pain, syncope, difficulty breathing). In 2008, we surveyed the radiology departments of Pennsylvania hospitals about the use of CT and V/Q scanning for PE, service availability hours, and what equipment was used. RESULTS: In all data, we found that CT was used approximately six times as frequently as V/Q scanning. In the Medicare data, only small differences in frequency of use of CT and V/Q scanning were associated with hospital characteristics. Academic hospitals did not differ in a major way from other hospitals, nor did small or rural hospitals. In the survey, 97% of radiology departments reported that CT was available for evaluation of PE 24 hours a day 7 days a week. Ninety-three percent of departments reported V/Q scanning was available at some times; 77% reported V/Q available at all times. CONCLUSION: CT was a fully disseminated and dominant technique for the diagnosis of PE by 2005, and it was readily available at small and rural hospitals. The lack of availability of off-hours V/Q scanning at a substantial fraction of hospitals may be a problem for patients with contraindications to CT.