CT pulmonary angiography utilization in the emergency department: diagnostic yield and adherence to current guidelines

Am J Med Qual. Nov-Dec 2015;30(6):571-7. doi: 10.1177/1062860614543302. Epub 2014 Jul 18.

Abstract

The aim is to investigate the patterns of computed tomography pulmonary angiography (CTPA) use and adherence to current guidelines. Medical records of patients investigated with CTPA for pulmonary embolism (PE) in a single academic hospital from January 2011 until December 2012 were reviewed. Wells scores were calculated retrospectively by researchers blinded to the results of the CTPA. "Avoidable imaging" was defined as imaging performed against current recommendations of the European Society of Cardiology or the PIOPED investigation group. A total of 646 patients underwent testing; 61 cases of PE were diagnosed (9.4%). Potentially avoidable imaging was performed in 49.5% and 71.5% of patients, depending on the criteria used; 11.5% of imaging studies were performed in low-risk patients with negative D-dimer assays. There is evidence of CTPA overuse and D-dimer underuse. Adherence to guidelines and appropriate use of D-dimer assay might reduce avoidable imaging and ionizing radiation exposure.

Keywords: D-dimer; Wells score; computed tomography; pulmonary embolism.

MeSH terms

  • Academic Medical Centers
  • Adult
  • Aged
  • Aged, 80 and over
  • Computed Tomography Angiography
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / diagnostic imaging*
  • Retrospective Studies
  • Single-Blind Method
  • Unnecessary Procedures / statistics & numerical data*

Substances

  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D