Journal article
Overutilisation of imaging studies for diagnosis of pulmonary embolism: are we following the guidelines?
Postgraduate medical journal, Vol.95(1126), pp.420-424
08/2019
DOI: 10.1136/postgradmedj-2018-135995
PMID: 30665902
Abstract
ObjectiveTo 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).MethodsWe 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.ResultsA 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.ConclusionMore 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.
Details
- Title: Subtitle
- Overutilisation of imaging studies for diagnosis of pulmonary embolism: are we following the guidelines?
- Creators
- Prajwal Dhakal - University of Nebraska Medical CenterMian Harris Iftikhar - Michigan State UniversityLing Wang - Michigan State UniversityVarunsiri Atti - Michigan State UniversitySagar Panthi - Michigan State UniversityXiao Ling - Michigan State UniversityMark T P Mujer - Michigan State UniversityOm Dawani - Michigan State UniversityManoj P Rai - Michigan State UniversityShilpa Tatineni - Michigan State UniversityShiva Shrotriya - Michigan State UniversitySupratik Rayamajhi - Michigan State University
- Resource Type
- Journal article
- Publication Details
- Postgraduate medical journal, Vol.95(1126), pp.420-424
- DOI
- 10.1136/postgradmedj-2018-135995
- PMID
- 30665902
- ISSN
- 0032-5473
- eISSN
- 1469-0756
- Language
- English
- Date published
- 08/2019
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984359764702771
Metrics
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