CT Pulmonary Angiography (CTPA) Frequently Identifies an Alternative Diagnosis in a Post-Orthopedic Population: A Retrospective Review of 372 Consecutive Orthopedic Patients Evaluated for Pulmonary Embolism (PE)

SESSION TITLE: Pulmonary Vascular Disease - PE/DVT SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Perioperative orthopedic patients are at high risk for both venous thromboembolic (VTE) and non-VTE related clinical complications. Identifying a non-PE diagnosis to explain clinical decompensation may not adequately exclude a concurrent thromboembolic event in this specific population. METHODS: We gathered consecutive data retrospectively for all patients suspected of having a PE who received a CTPA scan from June 2013 until October 2014. Demographic data, presenting signs and symptoms, findings on CTPA including non-PE diagnoses, and survival to hospital discharge were recorded. Categorical variables were compared between groups (PE vs. non-PE) using chi-square test. RESULTS: Three hundred and seventy-two patients were scanned during the study period of which 67 (18%) were found to have PE. Baseline demographic and clinical data was similar between groups (age, gender, race, BMI, presence of prior DVT, presence of fracture). There was no difference between those found to have PE and not with regard to presence of chest pain, lower extremity edema, hypotension (systolic blood pressure < 100mmHg), or hypoxia (SpO2 <90%). Alternative radiographic findings on CTPA were common in both the PE and non-PE group; more than 50% of patients in both groups had atelectasis and 40% vs. 31% had pleural effusion in the PE and non-PE group, respectively. There was no difference in the VTE prophylactic agents used between groups. Overall, there was no significant difference in survival between groups (100% survival in PE group vs. 98.3% survival in non-PE group). CONCLUSIONS: Orthopedic patients frequently have both VTE and non-VTE perioperative complications that may mimic each other in their clinical presentation. Identifying PE in an orthopedic patient does not exclude additional concurrent pathologies that may have produced clinical decompensation. CLINICAL IMPLICATIONS: Clinicians should have a low threshold for diagnostic workup for PE in the orthopedic population even when an alternative etiology for cardio-respiratory compromise may be present. DISCLOSURE: The following authors have nothing to disclose: Jonathan Mendelson, Manish Kumar, Vikramjit Mukherjee, Radu Postelnicu, Meghan Ward, David Steiger, Ezra Dweck No Product/Research Disclosure Information