Key result
Suboptimal implementation of diagnostic algorithms resulted in 61% of low-risk patients undergoing computed tomography-pulmonary angiography without prior D-dimer testing.
Observational (n=2,031)
No
Suboptimal implementation of pretest probability assessment tools for suspected pulmonary embolism results in significant overuse of CTPA, contributing to ineffective resource utilization and potential patient harm.
Highlights ongoing overuse of CT pulmonary angiography; supports targeted implementation research to close diagnostic algorithm gaps.
BACKGROUND: Majority of our computed tomography-pulmonary angiography (CTPA) scans report negative findings. We hypothesized that suboptimal reliance on diagnostic algorithms contributes to apparent overuse of this test. METHODS: A retrospective review was performed on 2031 CTPA cases in a large hospital system. Investigators retrospectively calculated pretest probability (PTP). Use of CTPA was considered as inappropriate when it was ordered for patients with low PTP without checking D-dimer (DD) or following negative DD. RESULTS: Among the 2031 cases, pulmonary embolism (PE) was found in 7.4% (151 cases). About 1784 patients (88%) were considered "PE unlikely" based on Wells score. Out of those patients, 1084 cases (61%) did not have DD test prior to CTPA. In addition, 78 patients with negative DD underwent unnecessary CTPA; none of them had PE. CONCLUSIONS: The suboptimal implementation of PTP assessment tools can result in the overuse of CTPA, contributing to ineffective utilization of hospital resources, increased cost, and potential harm to patients.
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Alhassan et al. (2016) conducted an observational in Suspected pulmonary embolism (n=2,031). Suboptimal implementation of diagnostic algorithms (Wells score and D-dimer) vs. Adherence to diagnostic algorithms was evaluated on Noncompliance with evidence-based guidelines (CTPA ordered without checking D-dimer or following negative D-dimer in 'PE unlikely' group). Suboptimal implementation of diagnostic algorithms resulted in 61% of low-risk patients undergoing computed tomography-pulmonary angiography without prior D-dimer testing.
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