Key result
Rising ED CTPA use is linked to a ~14% annual increase in low-risk PE diagnoses.
Why the study?
Validated clinical decision rules have been developed to avoid unnecessary use of CTPA in patients with suspected PE in the ED, but changes in CTPA use over time were unclear.
Has the use of CTPA for suspected PE in the ED changed over time following the validation of clinical decision rules?
Observational
Yes
Has the use of CTPA for suspected PE in the ED changed over time following the validation of clinical decision rules?
p-value: p=0.028
Despite the validation of clinical decision rules to limit unnecessary imaging, CTPA rates for suspected PE in the ED have increased, resulting in more diagnoses of low-risk PEs.
Rising CTPA use despite decision rules may increase low-risk PE diagnoses; leaves open whether rules are underimplemented in practice.
BACKGROUND: Recently, validated clinical decision rules have been developed that avoid unnecessary use of computed tomographic pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) in the emergency department (ED). OBJECTIVE: To measure any resulting change in CTPA use for suspected PE. DESIGN: Retrospective analysis. SETTING: 26 European EDs in 6 countries. PATIENTS: Patients with CTPA performed for suspected PE in the ED during the first 7 days of each odd month between January 2015 and December 2019. MEASUREMENTS: The primary end points were the CTPAs done for suspected PE in the ED and the number of PEs diagnosed in the ED each year adjusted to an annual census of 100 000 ED visits. Temporal trends were estimated using generalized linear mixed regression models. RESULTS: = 0.028), a higher proportion of low-risk PEs (annual percent change [APC], 13.8% [95% CI, 2.6% to 30.1%]) with more ambulatory management (APC, 19.3% [CI, 4.1% to 45.1%]), and a lower proportion of intensive care unit admissions (APC, -8.9% [CI, -17.1% to -0.3%]) were observed. LIMITATION: Data were limited to 7 days every 2 months. CONCLUSION: Despite the recent validation of clinical decision rules to limit the use of CTPA, an increase in the CTPA rate along with more diagnosed PEs and especially low-risk PEs were instead observed. PRIMARY FUNDING SOURCE: None specific for this study.
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Roussel et al. (2023) conducted an observational in Suspected pulmonary embolism. Temporal trends was evaluated on CTPAs done for suspected PE in the ED and the number of PEs diagnosed in the ED each year adjusted to an annual census of 100 000 ED visits (p=0.028). Temporal trends from 2015 to 2019 showed an increase in CTPA use and a higher proportion of low-risk PEs diagnosed (annual percent change 13.8%; 95% CI 2.6% to 30.1%).
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