Application of a diagnostic strategy for patients with suspected pulmonary embolism in a middle-income country

BACKGROUND: The implementation of diagnostic strategies in patients with suspected pulmonary embolism (PE) aims to reduce lethality and optimize hospital resources. The objectives of the present study were to describe the use of computed tomographic pulmonary angiography (CTPA) in a hospital located in a middle-income country and apply a diagnostic strategy to optimize the use of CTPA in the management of patients with suspected PE, while also evaluating its impact on hospital costs. METHODS: Retrospective observational study. All CTPA studies ordered in patients with suspected PE during the study period were reviewed. CTPA requests from hospitalized and emergency department patients for suspected PE were included. Patients treated in outpatient clinics, with hemodynamic instability, incomplete medical history, pregnant women, and those under 18 years old were excluded. The Student’s t-test for paired samples was used to compare CTPA-related costs. RESULTS: CTPA was performed on 103 patients with suspected PE and 85 patients met the inclusion criteria. The diagnosis of PE was confirmed by CTPA in 13% [n = 11] of patients. Out of the 85 patients included, the diagnostic strategy could not be applied in 14 of them due to the unavailability of D-dimer. We found that the use of the diagnostic strategy would reduce CTPA requests by at least 20% and could significantly decrease hospital costs ($26,746 in all included patients vs. $17,621 with diagnostic strategy, p = 0.01). CONCLUSIONS: Among all patients suspected of PE, 13% were confirmed by CTPA. The use of the diagnostic strategy decreases the percentage of CTPA requests and, consequently, significantly reduce patient irradiation and hospital costs.