CTPA or V/Q scans for suspected pulmonary embolism yielded a positive diagnosis in only 1.7% of 8,449 patients, highlighting extraordinary overutilization of imaging despite guidelines.
Cohort (n=8,449)
No
Are imaging studies for the diagnosis of pulmonary embolism ordered according to current guidelines in adult emergency department patients?
There is significant overutilization of imaging for PE diagnosis in the emergency department, highlighting the need for greater adherence to guidelines using Wells' criteria and d-dimer testing.
OBJECTIVE: To evaluate if imaging studies such as CT pulmonary angiography (CTPA) or ventilation-perfusion (V/Q) scan are ordered according to the current guidelines for the diagnosis of pulmonary embolism (PE). METHODS: We performed a retrospective observational cohort study in all adult patients who presented to the Sparrow Hospital Emergency Department from January 2014 to December 2016 and underwent CTPA or V/Q scan. We calculated the Wells' score retrospectively, and d-dimer values were used to determine if the imaging study was justified. RESULTS: A total of 8449 patients underwent CTPA (93%) or V/Q scan (7%), among which 142 (1.7%) patients were diagnosed with PE. The Wells' criteria showed low probabilities for PE in 96 % and intermediate or high probabilities in 4 % of total patients. Modified Wells' criteria demonstrated PE unlikely in 99.6 % and PE likely in 0.4 % of total patients. D-dimer was obtained in only 37 % of patients who were unlikely to have a PE or had a low score on Wells' criteria. Despite a low or unlikely Wells' criteria score and normal d-dimer levels, 260 patients underwent imaging studies, and none were diagnosed with PE. CONCLUSION: More than 99 % of CTPA or V/Q scans were negative in our study. This suggests extraordinary overutilisation of the imaging methods. D-dimer, recommended in patients with low to moderate risk, was ordered in only one-third of patients. Much greater emphasis of current guidelines is needed to avoid inappropriate utilisation of resources without missing diagnosis of PE.
Dhakal et al. (Mon,) conducted a cohort in Suspected pulmonary embolism (n=8,449). CT pulmonary angiography (CTPA) or ventilation-perfusion (V/Q) scan was evaluated on Diagnosis of pulmonary embolism. CTPA or V/Q scans for suspected pulmonary embolism yielded a positive diagnosis in only 1.7% of 8,449 patients, highlighting extraordinary overutilization of imaging despite guidelines.
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