Effect of age on the performance of single detector helical computed tomography in suspected pulmonary embolism

Marc Righini; Henri Bounameaux; Arnaud Perrier

doi:10.1160/TH03-07-0429

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2004; 91(02): 296-299
DOI: 10.1160/TH03-07-0429

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Effect of age on the performance of single detector helical computed tomography in suspected pulmonary embolism

Marc Righini

¹Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland

,

Henri Bounameaux

¹Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland

,

Arnaud Perrier

²Medical Clinic 1, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland

› Author Affiliations

Abstract

Summary

The prevalence of pulmonary embolism increases with age, but reduces the diagnostic yield of ventilation-perfusion lung scan age. Helical computed tomography (hCT) is widely used to diagnose pulmonary embolism, and should be less susceptible to the influence of age. We studied the influence of age on the performance of hCT to verify that hypothesis. We analyzed a database of 299 consecutive outpatients suspected of pulmonary embolism, in whom pulmonary embolism was diagnosed according to accepted criteria, and who were all submitted to a helical CT. We divided the patient population into tertiles, corresponding to the following age categories: less than 59 years (group 1), 60 to 75 years (group 2), and over 75 years (group 3). Sensitivity and specificity of hCT were calculated in each age category. Overall sensitivity was 70% (95% CI: 62 to 78) and specificity was 91% (95% CI: 86 to 95). Sensitivity was 81% (95% CI: 64 to 93) in group 1, 63% (95% CI: 46 to 78) in group 2, and 67 % (95% CI: 52 to 80) in group 3.The corresponding values for specificity were 92% (95% CI: 82 to 97) in group 1, 86% (95% CI: 75 to 94) in group 2 and 96% (95% CI: 87 to 100) in group 3. Positive predictive values ranged from 75% to 94% and negative predictive values from 77% to 94%. Our data suggest that age does not have a marked influence on the diagnostic performances of hCT in clinically suspected pulmonary embolism.

Keywords

Pulmonary embolism - age - helical computed tomography - sensitivity - specificity

Full Text

References

References
1 Busby W, Bayer A, Pathy J. Pulmonary embolism in the elderly. Age Ageing 1998; 17: 205-9.
2 Kniffin Jr WD, Baron JA, Barrett J. et al. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med 1994; 154: 861-6.
3 Lilienfeld DE, Chan E, Ehland J. et al. Mortality from pulmonary embolism in the United States: 1962 to 1984. Chest 1990; 98: 1067-72.
4 Perrier A, Desmarais S, Miron MJ. et al. Noninvasive diagnosis of venous thromboebolism in outpatients. Lancet 1999; 353: 190-5.
5 Wells PS, Anderson DR, Rodger M. et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med 2001; 135: 98-107.
6 Mullins MD, Becker DM, Hagspiel KD. et al. The role of spiral volumetric computed tomography in the diagnosis of pulmonary embolism. Arch Intern Med 2000; 160: 293-8.
7 Righini M, Goehring C, Bounameaux H. et al. Effects of age on the performance of common diagnostic tests for pulmonary embolism. Am J Med 2000; 109: 357-61.
8 Righini M, de Moerloose P, Reber G. et al. Should the D-dimer cut-off value be increased in elderly patients suspected of pulmonary embolism?. Thromb Haemost 2001; 85: 744.
9 Perrier A, Howarth N, Didier D. et al. Performances of helical computed tomography in unselected outpatients with suspected pulmonary embolism. Ann Intern Med 2001; 135: 88-97.
10 Van Strijen MJ, De Monye W, Schiereck J. et al. Single-detector helical computed tomography as the primary diagnostic test in suspected pulmonary embolism: a multicenter clinical management study of 510 patients. Ann Intern Med 2003; 138: 307-14.
11 Musset D, Parent F, Meyer G. et al. Diagnostic strategy for patients with suspected pulmonary embolism: a prospective multicentre outcome study. Lancet 2002; 360: 1914-20.
12 Perrier A, Roy PM, Aujesky D. et al. Diagnosing pulmonary embolism with clinical assessment, D-dimer, venous ultrasound and helical computed tomography: a multicenter management study. Am J Med. (in press).
13 The PIOPED Investigators. Value of the ventilation-perfusion scan in acute pulmonary embolism. JAMA 1990; 263: 2753-9.
14 Wells PS, Ginsberg JS, Anderson DR. et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 1998; 129: 997-1005.
15 Perrier A, Miron MJ, Desmarais S. et al. Using clinical evaluation and lung scan to rule out suspected pulmonary embolism: Is it a valid option in patients with normal results of lower-limb venous compression ultrasonography?. Arch Intern Med 2000; 160: 512-6.
16 Kearon C, Julian JA, Newman TE. et al. Noninvasive diagnosis of deep venous thrombosis. Ann Intern Med 1998; 128: 663-77.
17 Schoepf UJ, Holzknecht N, Helmberger TK. et al. Subsegmental pulmonary emboli: improved detection with thin-collimation multi-detector row spiral CT. Radiology 2002; 222: 483-90.