A multidisciplinary review of clinical data exchange concerning ordering of CT angiograms in patients with suspected pulmonary embolism.

Congress:

ECR 2019

Poster Number:

C-1959

Type:

Scientific Exhibit

Keywords:

Management, Pulmonary vessels, Professional issues, CT-Angiography, Structured reporting, Efficacy studies, Statistics, Quality assurance, Epidemiology, Workforce

Authors:

M. Buk¹, O. von Stackelberg², E. Giannitsis², L. Kihm², H. U. Kauczor², T. F. Weber²; ¹Prague/CZ, ²Heidelberg/DE

DOI:

10.26044/ecr2019/C-1959

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-1959

Table 1: Simplified revised Geneva Score clinical parameters overview.

Table 2: Actual PE findings according to the rGS-based risk stratification

Table 4: Other clinical parameters from the CTPA request forms, which are however not...

Table 3: Important clinical parameters included in the rGS, yet they were not...

Aims and objectives

CT pulmonary angiography (CTPA) is the gold standard imaging technique for suspected pulmonary embolism (PE). However, it carries the burden of radiation exposure and the need for using an iodine-based intravenous contrast agent. The aim of our study was to review if CTPA examinations were being correctly indicated in accordance with the ALARA principle and current diagnostic guidelines at the Department of Diagnostic and Interventional Radiology at the University Hospital in Heidelberg, Germany. For assessing the appropriateness of CTPA examinations, the diagnostic algorithm from ESC...

Methods and materials

CTPA examinations requested for clinical suspicion of PE dating from January 2017 to April 2018 were retrospectively analyzed. In total there were 285 cases, out of which we selected only clinically stable outpatients due to poorer D-dimer value reliability in hospitalized patients as mentioned above. The diagnostic algorithm is applicable only to clinically stable patients (in unstable patients CTPA is always indicated as mentioned above), which is why we excluded hospitalized patients. As a result, we included 155 cases. Data from hospital EHR and CTPA...

Results

In total, 155 clinically stable outpatients were reviewed. According to the data in RIS alone, 76% (117/155) met the guidelines for CTPA examination. When combined with the complete EHR data, 88% (137/155) examinations were correctly ordered. That leaves out 12% (18/155) cases in which the CTPA was not advised according to the guidelines. These 18 examinations were mostly requested from non-emergency departments, unlike the remaining 137 cases. Based on the RIS data alone, the average rGS was 0.877. When both the data from RIS and...

Conclusion

Despite complete rGS documentation in EHR, there was frequently a deficit of information relevant for justifying CTPA indications in the radiology department. Structured documentation of data and integrated information technology for data transfer is necessary for clinical decision making and formal justification of CT examinations. On average, more than one relevant important clinical parameter was omitted from the request form in each case. Clinically stable outpatients are a good source for this kind of research, as there are less false positive D-dimer values in this...

Personal information

Contact Information: Michal Buk, MD Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany Department of Radiology of Third Faculty of Medicine, Charles University and University Hospital University Kralovske Vinohrady, Prague, Czechia Srobarova 50 100 34 Prague, Czechia Phone: +420720331784 Fax: +420267162409 E-mail :[email protected] Author Information: Michal Buk (Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany; Department of Radiology of Third Faculty of Medicine, Charles University and University Hospital University Kralovske Vinohrady, Prague, Czechia) Oyunbileg von Stackelberg (Department of Diagnostic and Interventional...

References

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