Pulmonary Embolus (PE) is the third most common cause of death from cardiovascular disease [1]. Investigation and treatment of patients presenting to emergency departments poses a significant burden on healthcare resources as well as potentially impacting on patient safety through the radiation exposure and potential for contrast related illness implicit in the primary diagnostic study, CT Pulmonary Angiography (CTPA). Despite well known scoring systems for pretest probability of pulmonary embolus prior to CTPA such as the Wells' and Geneva scores, clinical approach to PE in...

Data was collected on CTPA ordering patterns prior to the introduction of our algorithim over several periods; July-September 2012, January 2013 and September 2013. This data was obtained via electronic records on the local PACS radiology ordering system. We assessed the total number of CTPAs performed, the total positivity rate in scans performed as well as evaluating the referral documentation as to whether a Wells' Score had been recorded or a d-dimer performed and the positivity rates. Subsequent to the introduction of our algorithim being...

In our data collection periods, prior to the introduction of the algorithim, we identified 204 CTPAs performed via the emergency department with an average of 41 scans per month over 5 months. 31 of these 204 (15%) scans were positive for pulmonary embolus. Documentation of any pretest probability score was low with only 16 of 204 (7.8%) having evidence of any score on request. 101 of 204(49.5%) of CTPAs performed had other clinically significant findings. Subsequent to the introduction of the algorithim, 174 CTPAs were...

This novel diagnostic algorithm allowed standardisation of clinical approach and pretest probability scoring for patients presenting to our emergency department with symptoms suggestive of PE. We found that the introduction of our algorithim into clinical practice acheived both an increase in the diagnostic yield and positivity rate for CTPAs performed via our emergency department as well as a decrease in the overall number of scans performed. There was a decrease in average scans performed per month from 41 to 35 (Fig. 3). Positive diagnoses for...

1. Goldhaber SZ Bounameaux H. “Pulmonary embolism and deep vein thrombosis”. Lancet. 2012 May 12;379(9828):1835-46 2. Sanjuan P et al. “Probability scores and diagnostic algorithms in pulmonary embolism: are they followed in clinical practice?”. Arch Bronconeumol. 2014 May;50(5):172-8. 3. Le Gal G et al. “Prediction of pulmonary embolism in the emergency department: the revised Geneva score”. Ann Intern Med. 2006 Feb 7;144(3):165-71 4. Ceriani E et al. “Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis”. J Thromb Haemost. 2010 May;8(5):957-70 5. Carrier...