Abstract
Background
Different patient characteristics influence the decision to order diagnostic imaging
for deep venous thrombosis (DVT) and pulmonary embolism (PE) in different settings
(emergency department (ED), hospital, and office). Diagnostic yield is defined as
the proportion of tests that report positive results. We hypothesize different patient
characteristics are associated with higher or lower diagnostic yield of imaging for
DVT and PE in different settings.
Methods
We used Optum Clinformatics™ national claims database (2015–2019) to assess the diagnostic
yield of imaging for DVT and PE in three settings: (a) ED discharge, (b) Hospitalized,
and (c) Office. We studied the patient characteristics associated with diagnostic
yield using logistic regression.
Results
Diagnostic imaging for DVT and PE was performed in 1,502,417 and 710,263 visits, respectively.
Diagnostic yield for DVT and PE was 9.8 ± 0.1 % and 12.7 ± 0.1 %, respectively in
the overall cohort. In the ED discharge, hospitalized, and office settings, diagnostic
yield for DVT was 10.4 ± 0.1 %, 16.9 ± 0.1 %, and 6.5 ± 0.1 %, respectively, and that
for PE 6.4 ± 0.1 %, 18.7 ± 0.1 %, and 8.8 ± 0.2 %, respectively. Of the patients who
underwent imaging for DVT, higher diagnostic yield was more likely with thrombophilia,
central venous access, and cancer. Of the patients who underwent imaging for PE, higher
diagnostic yield was most likely with thrombophilia, respiratory failure, and heart
failure or acute myocardial infarction.
Conclusions
In each setting, different patient characteristics influence the diagnostic yield
of imaging for DVT and PE and can inform clinical practice. Judicious use of imaging
for DVT and PE could reduce costs and avoid exposure to radiation and contrast.
Keywords
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Article info
Publication history
Published online: February 09, 2023
Accepted:
February 3,
2023
Received in revised form:
January 28,
2023
Received:
September 15,
2022
Identification
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