Pulmonary embolism: pulmonary angiogram was a good reference standard.

Clinical bottom line (level 4)

  1. Pulmonary angiogram diagnosed and ruled out pulmonary embolism.
  2. 0.5 % of patients died following the investigation.
Stein et al: Circulation 1992; 85: 462-468
Expires October 2003

The study

Setting: six clinical centres, USA

1111 patients (aged ?, ?% male) suspected pulmonary embolism

?independent unblinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • follow-up or autopsy: diagnosis review by PIOPED committee
Diagnostic test: pulmonary angiogram

The evidence


differential diagnosis number of patients prevalence
(95% CI)
non-diagnostic scan 35 3.2%
(2.1% to 4.2%)
death from scan 5 0.45%
(0.056% to 0.84%)
major complication from scan 9 0.81%
(0.28% to 1.34%)
minor complications from scan 60 5.4%
(4.1% to 6.7%)


diagnostic test pulmonary embolism no pulmonary embolism LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
positive angiogram 382 4 170
(64 to 450) 		99% 0.0026
(0.00037 to 0.019) 		0.15%
total 383 671

  • Major complications: respiratory distress requiring CPR or intubation; renal failure requiring dialysis; haematoma requiring transfusion of two or more units.
  • Minor complications: urticaria, pruritis; mild renal dysfunction

Comments

  1. Pulmonary angiography was used as a gold standard in the PIOPED trial - thus the number of false positives is uncertain. One autopsy was unable to demonstrate evidence of PE in a patient with a positive angiogram.

Citation

  1. Stein PD, Athanasoulis C, Alavi A, et al: Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation 1992; 85: 462-468
Contributor: Chris Ball and Clare Wotton, October 2000
Reviewer:

Clinical Question.
Patient suspected pulmonary embolism
Intervention or Exposure pulmonary angiogram
Outcome diagnosis of PE