Annals of Emergency Medicine
Volume 54, Issue 1 , Pages 41-48 , July 2009

Incidence and Predictors of Repeated Computed Tomographic Pulmonary Angiography in Emergency Department Patients

  • Jeffrey A. Kline, MD

      Affiliations

    • Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC
    • Corresponding Author InformationAddress for reprints: Jeffrey A. Kline, MD, Emergency Medicine Research, Department of Emergency Medicine, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28323-2861; 704-355-7092, fax 704-355-7047
    • ,
  • D. Mark Courtney, MD

      Affiliations

    • Department of Emergency Medicine, Northwestern Memorial Hospital, Feinberg School of Medicine, Chicago, IL
    • ,
  • Daren M. Beam, MD

      Affiliations

    • Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC
    • ,
  • Matthew C. King, BS

      Affiliations

    • Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC
    • ,
  • Mark Steuerwald

      Affiliations

    • Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC

Received 23 April 2008 ,Revised 5 August 2008 ,Accepted 14 August 2008.

References 

  1. Kline JA, Hernandez J, Jones AE, et al. Prospective study of the clinical features and outcomes of emergency department patients with delayed diagnosis of pulmonary embolism. Acad Emerg Med. 2007;14:592–598
  2. Courtney DM, Blackwell T, Kline JA. Prospective use of a prediction rule to identify pulmonary embolism as likely cause of outpatient cardiac arrest. Resuscitation. 2005;65:57–64
  3. Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6:772–780
  4. Fesmire FM, Kline JA, Wolf SJ. Clinical policy: critical issues in the evaluation and management of adult patients presenting with suspected pulmonary embolism. Ann Emerg Med. 2003;41:257–269
  5. Kline JA, Wells PS. Methodology for a rapid protocol to rule out pulmonary embolism in the emergency department. Ann Emerg Med. 2003;266–275
  6. Wicki J, Perneger T, Junod A, et al. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med. 2001;161:92–97
  7. Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model to categorize patients' probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000;83:416–420
  8. Kline JA, Nelson RD, Jackson RE, et al. Criteria for the safe use of D-dimer testing in emergency department patients with suspected pulmonary embolism: a multicenter United States study. Ann Emerg Med. 2002;39:144–152
  9. Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–2284
  10. Mitchell AM, Kline JA. Contrast nephropathy following computed tomography angiography of the chest for pulmonary embolism in the emergency department. J Thromb Haemost. 2007;5:50–54
  11. Kline JA, Mitchell AM, Runyon MS, et al. Electronic medical record review as a surrogate to telephone follow-up to establish outcome for diagnostic research studies in the emergency department. Acad Emerg Med. 2005;12:1127–1232
  12. Kline JA, Webb WB, Jones AE, et al. Impact of a rapid rule-out protocol for pulmonary embolism on the rate of screening, missed cases, and pulmonary vascular imaging in an urban U.S. emergency department. Ann Emerg Med. 2004;44:490–503
  13. Kalra MK, Saini S. Standardized nomenclature and description of CT scanning techniques. Radiology. 2006;241:657–660
  14. Richman PB, Wood J, Kasper DM, et al. Contribution of indirect computed tomography venography to computed tomography angiography of the chest for the diagnosis of thromboembolic disease in two United States emergency departments. J Thrombosis Haemostasis. 2003;1:652–657
  15. Richman PB, Courtney DM, Kline JA. Prevalence and significance of non-thromboembolic findings on chest computerized tomography angiography performed to rule-out pulmonary embolism: a multi-center study of 1025 emergency department patients. Acad Emerg Med. 2004;1:642–647
  16. Concato J, Feinstein A, Holford T. The risk of determining risk with multivariable models. Ann Intern Med. 1993;118:201–210
  17. McCaig LF, Burt CW. National hospital ambulatory medical care survey: 2002 emergency department summary. Adv Data. 2004;340:1–34
  18. Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA. 2007;298:317–323
  19. Lee CI, Haims AH, Monico EP, et al. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology. 2004;231:393–398
  20. Amis ES, Butler PF, Applegate KE, et al. American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol. 2007;4:272–284
  21. Kline JA, Hogg MM, Mauerhan DR, et al. Impact of anaesthesia-surgery on D-dimer concentration and end-tidal CO(2) and O(2) in patients undergoing surgery associated with high risk for pulmonary embolism. Clin Physiol Funct Imaging. 2008;28:161–168

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 Supervising editor: William R. Mower, MD, PhD

 Author contributions: JAK conceived the work, obtained funding, supervised the project, performed database queries, contributed to the primary analyses, and wrote the article. DMC performed the statistical and graphic analyses and edited the article. DMB, MCK, and MS performed database queries, data entry, and assisted with article production. JAK takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. JAK is inventor on US patent numbers 6,575,918; 6,881,193; 7,104,964. JAK owns stock in a company involved in developing a medical device referenced herein.

 Publication date: Available online October 5, 2008.

PII: S0196-0644(08)01639-9

doi: 10.1016/j.annemergmed.2008.08.015

Annals of Emergency Medicine
Volume 54, Issue 1 , Pages 41-48 , July 2009

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