scholarly journals CT pulmonary angiography appropriateness in a single emergency department: does the use of revised Geneva score matter?

2021 ◽  
Author(s):  
Alessandra Mirabile ◽  
Nicola Maria Lucarelli ◽  
Enza Pia Sollazzo ◽  
Amato Antonio Stabile Ianora ◽  
Angela Sardaro ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Clinical Judgment ◽  
Pulmonary Angiography ◽  
Suspected Pulmonary Embolism ◽  
Ct Pulmonary Angiography ◽  
Computed Tomography Pulmonary Angiography ◽  
Emergency Department Patients ◽  
Revised Geneva Score ◽  
D Dimer

Abstract Purpose To assess the percentage of computed tomography pulmonary angiography (CTPA) procedures that could have been avoided by methodical application of the Revised Geneva Score (RGS) coupled with age-adjusted D-dimer cut-offs rather than only clinical judgment in Emergency Department patients with suspected pulmonary embolism (PE). Material and methods Between November 2019 and May 2020, 437 patients with suspected PE based on symptoms and D-dimer test were included in this study. All patients underwent to CTPA. For each patient, we retrospectively calculated the age-adjusted D-dimer cut-offs and the RGS in the original version. Finally, CT images were retrospectively reviewed, and the presence of PE was recorded. Results In total, 43 (9.84%) CTPA could have been avoided by use of RGS coupled with age-adjusted D-dimer cut-offs. Prevalence of PE was 14.87%. From the analysis of 43 inappropriate CTPA, 24 (55.81%) of patients did not show any thoracic signs, two (4.65%) of patients had PE, and the remaining patients had alternative thoracic findings. Conclusion The study showed good prevalence of PE diagnoses in our department using only physician assessment, although 9.84% CTPA could have been avoided by methodical application of RGS coupled with age-adjusted D-dimer cut-offs.

scholarly journals Utilization of CT Pulmonary Angiography in Suspected Pulmonary Embolism in a Major Urban Emergency Department

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Adil Shujaat ◽  
Janet M. Shapiro ◽  
Edward Eden
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Clinical Information ◽  
Pulmonary Angiography ◽  
Suspected Pulmonary Embolism ◽  
Ct Pulmonary Angiography ◽  
Clinical Probability ◽  
Emergency Department Patients ◽  
One Year ◽  
D Dimer

Objectives. We conducted a study to answer 3 questions: (1) is CT pulmonary angiography (CTPA) overutilized in suspected pulmonary embolism (PE)? (2) What alternative diagnoses are provided by CTPA? (3) Can CTPA be used to evaluate right ventricular dilatation (RVD)?Methods. We retrospectively reviewed the clinical information of 231 consecutive emergency department patients who underwent CTPA for suspected PE over a one-year period.Results. The mean age of our patients was 53 years, and 58.4% were women. The prevalence of PE was 20.7%. Among the 136 patients with low clinical probability of PE, a d-dimer test was done in 54.4%, and it was normal in 24.3%; none of these patients had PE. The most common alternative findings on CTPA were emphysema (7.6%), pneumonia (7%), atelectasis (5.5%), bronchiectasis (3.8%), and congestive heart failure (3.3%). The sensitivity and negative predictive value of CTPA for (RVD) was 92% and 80%, respectively.Conclusions. PE could have been excluded without CTPA in ~1 out of 4 patients with low clinical probability of PE, if a formal assessment of probability and d-dimer test had been done. In patients without PE, CTPA did not provide an alternative diagnosis in 65%. In patients with PE, CTPA showed the potential to evaluate RVD.

scholarly journals An Analysis of Patients That Underwent Computed Tomography Pulmonary Angiography with the Prediagnosis of Pulmonary Embolism in the Emergency Department

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Engin Ozakin ◽  
Filiz Baloglu Kaya ◽  
Nurdan Acar ◽  
Arif Alper Cevik
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Pulmonary Angiography ◽  
Shortness Of Breath ◽  
Pathological Findings ◽  
Computed Tomography Pulmonary Angiography ◽  
Common Cause ◽  
Clinical Risks ◽  
The Relationship ◽  
D Dimer

Introduction.The purpose of this study is to analyze the frequency of other diagnoses and findings in patients that were diagnosed with or not diagnosed with PE following the CTPA in the ED and to analyze the relationship between diagnosis and D-dimer.Instrument and Method.This study involves all patients that presented to the ED that underwent CTPA with the prediagnosis of PE. The items considered in this study were their reason for presenting to the ED and pretest clinical risks for PE, D-dimer, and CTPA results.Findings.Of the 696 cases, the most common cause was shortness of breath (59.3%). The CTPA showed that 145 (20.83%) patients were suffering from PE. Among the remaining cases, 464 (66.66%) patients had pathological findings other than PE and 87 (12.5%) patients were reported as normal. The most common pathological results other than PE found in CTPA were atelectasis in 244 (39.9%) and ground glass in 165 (23.7%), as well as nonpulmonary results in 70 (10.05%) patients. The differences in D-dimer results of patients diagnosed with PE, patients diagnosed with another pathology, and patients with normal CTPA results were statistically significant (P<0.001).Conclusion.CTPA scanning, performed on the basis of assessment scoring, helps in discovering other fatal pathologies in addition to PE.

scholarly journals Utilization of serum D-dimer assays prior to computed tomography pulmonary angiography scans in the diagnosis of pulmonary embolism among emergency department physicians: a retrospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Leila Salehi ◽  
Prashant Phalpher ◽  
Hubert Yu ◽  
Jeffrey Jaskolka ◽  
Marc Ossip ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Diagnostic Yield ◽  
Pulmonary Angiography ◽  
Utilization Rate ◽  
Computed Tomography Pulmonary Angiography ◽  
Individual Physician ◽  
The Impact ◽  
D Dimer

Abstract Background A variety of evidence-based algorithms and decision rules using D-Dimer testing have been proposed as instruments to allow physicians to safely rule out a pulmonary embolism (PE) in low-risk patients. Objective To describe the prevalence of D-Dimer utilization among emergency department (ED) physicians and its impact on positive yields and utilization rates of Computed Tomography Pulmonary Angiography (CTPA). Methods Data was collected on all CTPA studies ordered by ED physicians at three sites during a 2-year period. Using a chi-square test, we compared the diagnostic yield for those patients who had a D-Dimer prior to their CTPA and those who did not. Secondary analysis was done to examine the impact of D-Dimer testing prior to CTPA on individual physician diagnostic yield or utilization rate. Results A total of 2811 CTPAs were included in the analysis. Of these, 964 CTPAs (34.3%) were ordered without a D-Dimer, and 343 (18.7%) underwent a CTPA despite a negative D-Dimer. Those CTPAs preceded by a D-Dimer showed no significant difference in positive yields when compared to those ordered without a D-Dimer (9.9% versus 11.3%, p = 0.26). At the individual physician level, no statistically significant relationship was found between D-Dimer utilization and CTPA utilization rate or diagnostic yield. Conclusion This study provides evidence of suboptimal adherence to guidelines in terms of D-Dimer screening prior to CTPA, and forgoing CTPAs in patients with negative D-Dimers. However, the lack of a positive impact of D-Dimer testing on either CTPA diagnostic yield or utilization rate is indicative of issues relating to the high false-positive rates associated with D-Dimer screening.

scholarly journals CORRELATION OF D-DIMER LEVEL WITH THE PRESENCE AND SEVERITY OF PULMONARY EMBOLISM ON COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY

2020 ◽  
pp. 33-34
Author(s):  
Mantavya Patel ◽  
Sanjay Paliwal ◽  
Rachit Saxena
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Early Diagnosis ◽  
Pulmonary Angiography ◽  
Clinical Suspicion ◽  
Early Prediction ◽  
Computed Tomography Pulmonary Angiography ◽  
Negative Prediction ◽  
D Dimer

Introduction: Early diagnosis of pulmonary embolism can reduce morbidity and motility. D-dimer is well known parameter having high negative prediction value. This study focused on role of D-dimer in early prediction of presence and severity of pulmonary embolism. Material and Methods: Thirty patients with clinical suspicion of pulmonary embolism along with high D-dimer value were included in this study. All selected patients underwent computed tomography pulmonary angiography assessment. D-dimer value was correlated with presence and proximity of pulmonary embolism. Results: Out of thirty selected patients 50% had pulmonary embolism on computed tomography pulmonary angiography assessment. D-dimer value correlated well with presence and proximity of pulmonary embolism. Conclusion: D-dimer value more than 4000 ng/ml had high positive prediction value (79%) in suspected clinical cases. Value more than 8000 ng/ml further improve value to nearly 100% in suspected cases.

scholarly journals Investigation of Suspected Pulmonary Embolism at Hutt Valley Hospital with CT Pulmonary Angiography: Current Practice and Opportunities for Improvement

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Nick Kennedy ◽  
Sisira Jayathissa ◽  
Paul Healy
Keyword(s):  
Pulmonary Embolism ◽  
Current Practice ◽  
Pulmonary Angiography ◽  
Pretest Probability ◽  
British Thoracic Society ◽  
Suspected Pulmonary Embolism ◽  
Ct Pulmonary Angiography ◽  
Wells Score ◽  
Positive Rate ◽  
D Dimer

Aims. To study the use of CT pulmonary angiography (CTPA) at Hutt Hospital and investigate the use of pretest probability scoring in the assessment of patients with suspected pulmonary embolism (PE).Methods. We studied patients with suspected PE that underwent CTPA between January and May 2012 and collected data on demographics, use of pretest probability scoring, and use of D Dimer and compared our practice with the British Thoracic Society (BTS) guideline.Results. 105 patients underwent CTPA and 15% of patients had PE. 13% of patients had a Wells score prior to their scan. Wells score calculated by researchers revealed 54%, 36%, and 8% patients had low, medium, and high risk pretest probabilities and 8%, 20%, and 50% of these patients had positive scans. D Dimer was performed in 58% of patients and no patients with a negative D Dimer had a PE.Conclusion. The CTPA positive rate was similar to other contemporary studies but lower than previous New Zealand studies and some international guidelines. Risk stratification of suspected PE using Wells score and D Dimer was underutilised. A number of scans could have been safely avoided by using accepted guidelines reducing resources use and improving patient safety.

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