Aims and objectives
BACKGROUND:
Pulmonary embolism (PE) is a serious condition with a high mortality rate if unrecognized [1].
Symptoms and signs of PE are often non-specific,
including chest pain,
dyspnea and syncope and clinical presentation of patients with suspected PE varies widely [2] making it hard to diagnose or exclude PE.
Computed tomography pulmonary angiogram (CTPA) is currently the preferred test to diagnose PE.
The fear of missing a diagnosis of this life-threatening disease has led to an increase in the use of invasive diagnostic strategies leading...
Methods and materials
Study setting & Patient assessment:
We conducted a retrospective chart review of Emergency Department (ED) encounters ofadult patients who underwent CTPAat our institute from Mar 2016 to Mar 2017.
Our institute is alarge,
urban,
academic ED of Level I trauma center.
Patients were evaluated and treated by their assigned physician according to individual physician practices.
No particular guidelines were reviewed with the physicians before this study,
nor were they encouraged to use one set of guidelines preferentially over another.
Methodology:
Patient demographics in the study...
Results
CTPA was ordered for 151 ER patients.
Out of these,
two patients were excluded from the study as one of them was less than 18 years of age & CTPA was inconclusive due to artefacts for one patient.
Hence 149 patients were considered eligible to be included in the study.
Of the 149 patients,
81 of them were males and rest 68 females.
(Fig.3)
Nearly 70% of the patients were in the age group of 30 -70 years (Fig.4)
According to Modified Well's score criterion,...
Conclusion
LIMITATIONS:
Our study had several limitations.First,
it was performed at a single institution; therefore,the results may not be generalizable toother institutions.
Second,
according tothe Wells criteria,
a d-dimer test shouldnot be ordered in patients with a Wellsscore greater than 4 because CT pulmonaryangiography is recommended.
Inour study,
patients with a Wells scoregreater than 4 whose provider did notattempt to order CT pulmonary angiographywere not capturedbecause the Wells score is recorded onlyduring computerized physician orderentry.
CONCLUSIONS:
13.5% CTPA could have been avoided in PE unlikely patients...
References
1 Miller AC,
Fennerty A.
British Thoracic Society guidelines for the management of suspected acute pulmonary embolism.
Thorax 2003;58:470–83.
2 Lavorini F,
Di Bello V,
De Rimini ML,
et al.
Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach.
Multidiscip Respir Med 2013;8:75–83.
3.
Rogg JG,
De Neve JW,
Huang C,
et al.
The triple work-up for emergency department patients with acute chest pain: how often does it occur? J Emerg Med 2011;40:128-34.
4.
Bettmann MA,
Baginski SG,
White RD,
et al.
ACR Appropriateness Criteria(R)...