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
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 group,
which is an important factor in the diagnostic guidelines.[1]
There were 12% (18) of cases where CTPA was not correctly indicated according to all the available clinical and laboratory data.
What was notable though was that these examinations were requested from mostly non-emergency departments,
and they were also the majority of all CTPA requests from these departments.
We compared the actual PE findings percentages to the results of the previous studies published by Ceriani et al.[2] The patients were stratified using the 3-level score into low-,
intermediate- and high-risk groups based on the rGS.
Results from the high-risk group cannot be compared as there is only one patient in this group.
The intermediate-risk group yielded 27 % PE findings,
which was in accordance with Ceriani et al.
(30 %).
Lastly,
there were 23 % PE findings in the low-risk group,
which was 13 % higher than previous studies showed.
However,
in 85 % (34/40) of these cases,
the CTPA was correctly indicated,
because the D-dimer values were greater than the cutoff.
When using the dichotomized score to identify the patients unlikely to have PE (the low clinical probability group),
there were 18% (17/63) positive PE findings in this group,
compared to 12% findings in previous studies.[2]