Value of the ventilation / perfusion scan in acute pulmonary ...

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., Table 3-Patienl Characteristics' Table 4-Comparison of Scan Category With Angiogram Findings Refuser! Pulmonary Pulmonary Pulmonary Ta - PtOPEO IN = 931l ineligible IN = 326) Scan Category Embolism Present Embolism Ab8ent Embolism Uncertain No Angiogram Tota' No, Age (mean), y 56.1 564 High probability 102 14 1 7 124 Male. % Service. % 45 44 Intermediate probability 105 217 9 33 364 Medical/CCU 40 Surgical 18 Emergency depanmenVcllnoc 30 36 21 32 low probability Near normai/normai ~ 39 5 199 50 12 2 62 74 312 131 H; - ICU 10 10 Total 251 480 24 178 931 ~ Other Hospital monaiity. % 1 9 1 10 La N; - 'PIOPED Indicates Prospective Investigation at Pul- To and monary ICU, Embolism intensive DiagnosIs' care unit." CCU coronary care unit. , " ,able 5.-Companson of Scan Category With Angiogram Findings. Sensitivity and SpecifICity - Scan Category High probability Sen81tlvtty, % 41 Specificit y % .' 97 cli High or intermediate probability 82 52 participate in PIOPED (Figure). The High. inlermediate. or low probability 98 10 clinical centers varied in the percentage er of eligible patients for whom consent could be obtained, from 33% to 70%, and p, a in the percentage of patients for whom of angiograms, respectively. In only 13 sitivity for thromboemboli on angiogra- U angiograms were obtained among those selected to determine the sen~tivity (1.7%) of i55 angiograms was panel adjudication necessary. phy increased to 207 (82%) of 251 (95% CI, 78% to 87%). If the patient had ei- ~ It and specificity of V /Q lung scans. (PIOPED angiographic pursuit). from Scan Findings ther a high-, intermediate-, or lowprobability V/Q scan, then 246 of 251 a; P 64% to 92% (Table 2). The PIOPED pa- Most (676) of the 931 patients had had thromboemboli on angiography, a \\ tients resembled refuser/ineligible pa- intermediate- or low-probability V/Q sensitivity of 98% (95% CI, 96% to (~ tients in a variety of clinical characteris- scan readings (39% and 34%, respec- 100%). tics (Table 3). The PIOPED patients tively) (Table 4). Only 131 (14%) had Only 14 (3%) of 480 patients who did: g and refuser/ineligible patients were different, however, in their lung scan abnormalities (P
~ Table 6 -Pulmonary Embolism (PE) Status' ul o. -~ Clinical Science Prob8bllity, % .- 24 -" 54 12 Scan Ca1egory 80.100 ~ +/No. of Patient. % 20-79 PE + /No. of Patient. % 0019 -. PE + /No of Patient. Of. All PTObabllltte. PE + /No of Patient. °/. .11 High probability 28/29 96 70/80 88 -5~ ~ -'1~~;;~'~'. ~~ .11 Intem1ediateprobability 27/41 66 66/236 2~ 1~~ ~~ ;~~ ~ -Low ., probability ,, , 6/15 ~- 40 30/191 ~~ ~ .~ ';~ ~,-~V ~ ,~ Near normal/normal ~ 0/5 0 4/62 ~-~~- 6 1/61 2 -~"~V 5/128 4 ~ Total 61~ 66 170/569 30 21/228 9 252/887 28 -emboll~m status IS based on anglogr~m Interpretation tor 713 patients, on angiogram interpretation and outcome classification commit1ee reassignment tor 4 patients, and on ~ CllnlCallntormation alone (wi1hout definitIVe angIography) tor 170 patients. -embolism was only 74% (14/19), com- before the scan was performed ("prior COMMENT pared with 91% (88/97) for those without probability") was compared with pula history of pulmonary embolism monary embolism status as determined The PIOPED study was conducted as ~- (~% ~Ict:ve valu,es reflects ,a,loss I)f specifi~- tion (T~~le 6) for 887 patients with pri.or mate the sensitivity and specificity of ei- Ity m the hIgh-probabIlity V/Q scan dI- probabIlIty assessments and defimte the V/Q lung scan for the diagnosis of ,w- agnosis for patie~ts with histories of pulmonary embolism status. A clinical pulmonary embolism. Other retrospec- :51 pulmonary embolIsm (88%) vs those assessment of 80% to 100% likelihood of tive and prospective studies have fo- .a with no prior pulmonary embolism pulmonary embolism was made in 00 cused on positive predictive values. to (98%) (P
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