Time Trends in Pulmonary Embolism in the United States
JAMA Internal Medicine,

Wiener RS et al. – 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.

Methods
  • 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.

Results
  • 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).

Please login or register to follow this author.
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Family Medicine

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Family Medicine Articles

1 Association of fat density with subclinical atherosclerosis Full Text Journal of the American Heart Association, September 19, 2014    Free full text

2 Androgen deprivation therapy for prostate cancer is associated with cardiovascular morbidity and mortality: A meta-analysis of population-based observational studies PLOS ONE, October 3, 2014    Clinical Article

3 A comparison of different oral therapies versus no treatment for erectile dysfunction in 196 radical nerve-sparing radical prostatectomy patients International Journal of Impotence Research: The Journal of Sexual Medicine, August 12, 2014    Clinical Article

4 Rapid and durable protection against Ebola virus with new vaccine regimens Full Text National Institute of Allergy and Infectious Disease - News, September 9, 2014    Free full text

5 Prostate health index vs percent free prostate-specific antigen for prostate cancer detection in men with “gray” prostate-specific antigen levels at first biopsy: Systematic review and meta-analysis Translational Research, The Journal of Laboratory and Clinical Medicine, October 8, 2014    Clinical Article

6 Neuroendocrine prostate cancer (NEPC) progressing from conventional prostatic adenocarcinoma: Factors associated with time to development of NEPC and survival from NEPC diagnosis-a systematic review and pooled analysis Journal of Clinical Oncology, September 22, 2014    Evidence Based Medicine    Review Article

7 Transurethral intraprostatic injection of botulinum toxin type a for the treatment of chronic prostatitis/chronic pelvic pain syndrome: Results of a prospective pilot double-blind and randomized placebo-controlled study BJU International, October 24, 2014    Clinical Article

8 Single animal to human transmission event responsible for 2014 Ebola outbreak Full Text NIH News, September 2, 2014    Free full text

9 Dutasteride plus Tamsulosin fixed-dose combination first-line therapy versus Tamsulosin Monotherapy in the treatment of benign prostatic hyperplasia: A budget impact analysis in the Greek healthcare setting Full Text BMC Urology, October 1, 2014    Free full text    Clinical Article

10 Midlife dietary vitamin D intake and subsequent performance in different cognitive domains Annals of Nutrition and Metabolism, September 16, 2014    Clinical Article

11 Thiopurines and risk of colorectal neoplasia in patients with inflammatory bowel disease: A meta-analysis Clinical Gastroenterology and Hepatology , September 26, 2014    Evidence Based Medicine

12 Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: A meta-analysis Family Practice, October 1, 2014    Evidence Based Medicine

13 Aromatherapy for stress reduction in healthy adults: A systematic review and meta-analysis of randomized clinical trials Maturitas, September 3, 2014    Evidence Based Medicine

14 The effect of bupropion XL and escitalopram on memory and functional outcomes in adults with major depressive disorder: Results from a randomized controlled trial Psychiatry Research, August 4, 2014    Clinical Article

15 A randomized controlled study to evaluate the efficacy of tamsulosin monotherapy and its combination with mirabegron on patients with overactive bladder induced by benign prostatic obstruction The Journal of Urology, October 30, 2014    Clinical Article

16 Effect of anti-inflammatory treatment on depression, depressive symptoms, and adverse effects: A systematic review and meta-analysis of randomized clinical trials JAMA Psychiatry, October 21, 2014    Evidence Based Medicine    Clinical Article

17 Effect of reiki therapy on pain and anxiety in adults: an in-depth literature review of randomized trials with effect size calculations Pain Management Nursing, October 6, 2014    Review Article

18 Daily aspirin use and prostate cancer–specific mortality in a large cohort of men with nonmetastatic prostate cancer Journal of Clinical Oncology, October 24, 2014    Clinical Article

19 Early short-term doxycycline therapy in patients with acute myocardial infarction and left ventricular dysfunction to prevent the ominous progression to adverse remodelling: The TIPTOP trial Full Text European Heart Journal, October 18, 2013    Free full text    Clinical Article

20 Urinating standing versus sitting: Position is of influence in men with prostate enlargement. A systematic review and meta-analysis PLOS ONE, August 1, 2014    Evidence Based Medicine    Review Article
Exclusive Author Commentary

Indexed Journals in Family Medicine: American Family Physician, Archives of Family Med, Annals of Family Medmore