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 EHR were put together,
the average rGS was 2.161,
which was higher by 1.284.
According to the rGS and the dichotomized score,
there were 41% (63/155) patients with high pretest clinical probability of PE and 59% (92/155) with low probability.
As for clinical findings in these groups,
in 36% (23/63) and 18% (17/92) respectively CTPA confirmed PE diagnosis.
In 73% (113/155) cases,
D-dimer value was greater than the cutoff.
Of these,
66% (74/113) were not eligible for CTPA according to the rGS,
so D-dimer value alone justified the CTPA examination.
The PE findings in relation to the risk stratification based on the 3-level score are stated below (see Table 2).
Table 2: Actual PE findings according to the rGS-based risk stratification
References: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
Most common rGS clinical parameters which were marked positive were tachycardia,
active malignancy,
previous deep vein thrombosis (DVT) or PE and surgery or bone fracture within the last month.
Commonly these parameters were noted in the EHR but were not transferred to the request forms in RIS,
as you can see in the table below.
D-dimer value is included in this selection as well,
though this was not relevant as the laboratory software where the value had to be looked up was regarded as part of RIS for the sake of this study (see Table 3).
Table 3: Important clinical parameters included in the rGS, yet they were not transferred to the CTPA request forms
References: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
Other clinical symptoms,
that were not part of the rGS,
were also noted.
They represent parameters that were present on the request forms,
not in EHR.
We noted the most commonly recurring ones (see Table 4).
Table 4: Other clinical parameters from the CTPA request forms, which are however not included in the rGS scoring
References: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany