Pulmonary embolism at follow-up outpatient CT pulmonary angiography: implications on patient risk stratification

Risk of pulmonary embolism after a prior negative CT pulmonary angiogram

CONTEXT

With increasing utilization of computed tomography pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism (PE), many patients undergo repeat CTs.

OBJECTIVE

The aim of this study is to identify the rate of positive subsequent CTPAs after an initial negative CTPA and whether there is a risk-free period after a negative CTPA.

METHODS

We evaluated 318 patients with at least 1 subsequent CTPA after an initial negative CTPA, with 786 total CTPAs. We also evaluated a control group of 200 unselected CTPAs.

RESULTS

The positive rate in the repeat group was 7% at the first repeat CTPA and 10% per-patient within 1000 days. The positive rate in the control group was 9% (P= not significant). No risk-free period was seen, with a positive rate of 5% within 2 weeks after a negative CTPA. The number of prior negative CTPAs showed a trend towards decreasing rate of the subsequent CTPA being positive, but this did not meet statistical significance.

DISCUSSION

There is no risk-free period after an initial negative CTPA, and therefore, patients with clinical suspicion of PE should be rescanned even after a recent negative study. Even patients with multiple negative prior CTPAs have a measurable risk of subsequent PE. Established clinical prediction scoring systems must be used to triage the patients who need CTPAs.