Abstract
Introduction. The purpose of this study is to assess referral patterns and the yield of ventilation-perfusion (V/Q) scintigraphy in patients referred for acute pulmonary embolism (PE). Methods. We retrospectively reviewed the charts of all patients who underwent V/Q studies between April 1, 2008, and March 31, 2010. Patients were subdivided into 4 groups based on their referral source: emergency department (ED), hospital inpatient ward, outpatient thrombosis clinic, and all other outpatient sources. Results. A total of 1008 patients underwent V/Q scintigraphy to exclude acute PE. The number of ED, inpatient, thrombosis clinic, and outpatient studies was 43 (4.3%), 288 (28.6%), 351 (34.8%), and 326 (32.3%). Proportion of patients with contrast contraindication varied significantly among the different groups. Of the 1,008 studies, 331 (32.8%) were interpreted as normal, 408 (40.5%) as low, 158 (15.7%) as intermediate, and 111 (11.0%) as high probability for PE. 68 (6.7%) patients underwent CTPA within 2 weeks following V/Q. Conclusion. The rate of nondiagnostic studies is lower than that reported in previously published data, with a relatively low rate of intermediate probability studies. Only a small fraction of patients undergoing a V/Q scan will require a CTPA.
Highlights
The purpose of this study is to assess referral patterns and the yield of ventilation-perfusion (V/Q) scintigraphy in patients referred for acute pulmonary embolism (PE)
The average age of the 4 groups differed significantly and was significantly greater in the inpatient ward (INPT) group compared to all other groups (p < 0.01) and in the outpatient sources (OUTPT) group compared to thrombosis clinic (TCLINIC) (p < 0.001)
Proportion of pregnant females differed within the females of each group (p = 0.0024), with the highest proportion observed in the TCLINIC group, and a significantly greater proportion of pregnant females noted in the TCLINIC compared to the OUTPT group (p = 0.029)
Summary
The purpose of this study is to assess referral patterns and the yield of ventilation-perfusion (V/Q) scintigraphy in patients referred for acute pulmonary embolism (PE). Pulmonary embolism (PE) is a relatively common condition affecting patients of all age groups, usually arising from thrombi developing in the lower extremity deep venous system [1]. Patients with acute pulmonary embolism tend to have nonspecific signs and symptoms making clinical diagnosis challenging [3]. Several noninvasive diagnostic tools are available to evaluate patients with suspected acute pulmonary embolism, including lower extremity ultrasound, D-dimer titers, CT pulmonary angiography (CTPA), and perfusion-ventilation (V/Q) scintigraphy. Increased use of CTPA may be associated with detection of incidental findings requiring further investigation, often leading to unnecessary and lowyield follow-up studies [9]
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