Keywords:
Quality assurance, Embolism / Thrombosis, Education and training, Radiation safety, Outcomes analysis, Health policy and practice, RIS, CT-Angiography, Vascular, Pulmonary vessels, Emergency
Authors:
P. GUPTA1, M. Saif2, Z. Munir2, A. Makki2; 1DUBAI, No/AE, 2DUBAI/AE
DOI:
10.26044/ecr2019/C-3473
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 to a significant rise of computed tomographic pulmonary angiography (CTPA) use over the last decade [3,4].
Excessive use of CTPA in the emergency department (ED) is associated with risks and costs to patients and systems of care.
Nevertheless,
it is often possible to save patients unnecessary radiation exposure,
unnecessary contrast administration,
and undue cost by implementing workup algorithms that safely rule out PE.
In the workup of PE,
several clinical decision rules have been proposed to guide proper use of diagnostic studies.
Of these,
the Wells score has been shown to identify patients with a low clinical risk on PE most accurately[5].When pretest probability is determined to be low,
international guidelines recommend to measure D-dimer levels:[6] a negative (usually below the threshold of 500 μg/mL) D-dimer level in combination with a low pretest probability excludes PE with high accuracy,
whereas a positive D-dimer level warrants further diagnostic imaging studies,
usually with CT pulmonary angiography (CTPA).
AIMS & OBJECTIVES:
- To identify the number of adult patients recommended CTPA in accordance to the Modified Well's score.(Fig.
1)
- To determine the number of avoidable CTPA