EM Nerd - December 8, 2016 by Rory Spiegel
"The existence of overdiagnosis in the pursuit of pulmonary embolism (PE) is undeniable. But the burden of clinically insignificant PEs diagnosed by our current hypersensitive, zero-miss culture is less apparent. The authors of a recent article ironically entitled RESPECT-ED, attempted to quantify the role in which overdiagnosis plays in the current incidence of PE.
The authors conclude that:
Higher CTPA utilization was positively correlated with PE diagnoses, but without evidence of increased proportions of small PE. This suggests that increased diagnoses seem to be of clinically relevant sized PE.
The RESPECT-ED data set is not wrong. Rather our understanding of the clinical importance of anatomic disease burden is incomplete. Such analyses do not account for the physiologic turmoil surrounding the emboli. Without an understanding of the patients who experiences these embolic injuries, it is impossible to assign any clinical weight to their existence. And so the best that can be said from RESPECT-ED is the more PEs one endeavors to find the more one will be rewarded with anatomically definable disease. The clinical relevance of these findings is still unclear."