Time Trends in Pulmonary Embolism in the United States

JAMA Internal Medicine, 05/11/2011

The introduction of computed tomographic pulmonary angiography (CTPA) was associated with changes consistent with overdiagnosis: rising incidence, minimal change in mortality, and lower case fatality. Better technology allows us to diagnose more emboli, but to minimize harms of overdiagnosis the authors must learn which ones matter.


  • To assess the impact of CTPA on national PE incidence, mortality, and treatment complications, the authors conducted a time trend analysis using the Nationwide Inpatient Sample and Multiple Cause–of–Death databases.
  • The authors compared age–adjusted incidence, mortality, and treatment complications (in–hospital gastrointestinal tract or intracranial hemorrhage or secondary thrombocytopenia) of pulmonary embolism (PE) among US adults before (1993–1998) and after (1998–2006) CTPA was introduced.


  • Pulmonary embolism incidence was unchanged before CTPA (P = .64) but increased substantially after CTPA (81% increase, from 62.1 to 112.3 per 100 000; P < .001).
  • Pulmonary embolism mortality decreased during both periods: more so before CTPA (8% reduction, from 13.4 to 12.3 per 100 000; P < .001) than after (3% reduction, from 12.3 to 11.9 per 100 000; P = .02).
  • Case fatality improved slightly before (8% decrease, from 13.2% to 12.1%; P = .02) and substantially after CTPA (36% decrease, from 12.1% to 7.8%; P < .001).
  • Meanwhile, CTPA was associated with an increase in presumed complications of anticoagulation for PE: before CTPA, the complication rate was stable (P = .24), but after it increased by 71% (from 3.1 to 5.3 per 100 000; P < .001).

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