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Editor's Correspondence
Nov 28, 2011

Caution on Interpreting the Time Trends in Pulmonary Embolism as “Overdiagnosis”

Author Affiliations

Author Affiliations: Divisions of Hematology (Dr Ashrani) and Cardiovascular Diseases, Section of Vascular Diseases, Department of Internal Medicine (Dr Heit), College of Medicine, Mayo Clinic, Rochester, Minnesota.

Arch Intern Med. 2011;171(21):1963-1964. doi:10.1001/archinternmed.2011.549

Wiener et al1(p831) conclude that the “introduction of CTPA [computed tomographic pulmonary angiography] was associated with changes consistent with overdiagnosis” of acute pulmonary embolism (PE) and suggest that such overdiagnosis is leading to increasing anticoagulant-related bleeding complications from overtreatment with no reduction in mortality. The authors' title suggests that they report “evidence of overdiagnosis.” However, it is important to point out that no direct evidence of overdiagnosis is presented. Specifically, only the incidence of PE hospital discharge diagnosis codes from aggregate administrative-level data are reported; PE incidence by review of individual-level medical records using accepted criteria for objectively diagnosed PE was not measured.

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