WTP2.11 Assessing the appropriateness of CTPA in Investigating Suspected Pulmonary Embolism in General Surgical Patients at a Tertiary Trauma Centre

Aims To assess the use of computed tomography pulmonary angiogram (CTPA) in General Surgical patients against Royal College of Radiologists (RCR) recommendations. CTPA, the gold standard for diagnosing pulmonary embolism (PE), is costly and exposes patients to significant ionising radiation. RCR advises following local protocols (2-level Wells score, D-dimer, and chest X-ray) before CTPA. Methods A list of 50 CTPA requests for inpatients from the Digestive Diseases wards was retrieved from the picture archiving and communication system (PACS) between January and May 2024. Data were collected anonymously using an Excel sheet and electronic patient records. Of these, 27 requests meeting inclusion criteria (general surgical patients, clinically diagnostic scans, and clinical suspicion) were analysed. Results Of the CTPA requests, 59% included a documented Wells score, 67% had a chest X-ray (CXR) performed, and 19% had a D-dimer test within the two days preceding the scan. Pulmonary embolism (PE) was identified in 8% of scans, with only 4% representing new diagnoses. Alternative lung pathologies were reported in 77% of scans, while 15% showed no detectable lung pathology. Among the 5 patients with a D-dimer test performed (19%), all results were elevated, yet none had a confirmed diagnosis of PE. Conclusion This study highlights inconsistent adherence to guidelines for CTPA usage, with suboptimal documentation of Wells scores, chest X-rays, and D-dimers. Improved compliance with protocols could reduce unnecessary scans, enhance diagnostic accuracy, and minimize patient exposure to ionising radiation.