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
Conclusion
LIMITATIONS:
Our study had several limitations. First,
it was performed at a single institution; therefore, the results may not be generalizable to other institutions.
Second,
according to the Wells criteria,
a d-dimer test should not be ordered in patients with a Wells score greater than 4 because CT pulmonary angiography is recommended.
In our study,
patients with a Wells score greater than 4 whose provider did not attempt to order CT pulmonary angiography were not captured because the Wells score is recorded only during computerized physician order entry.
CONCLUSIONS:
- 13.5% CTPA could have been avoided in PE unlikely patients with negative D-dimer
- Interestingly,
in PE likely patients with negative D-dimer,
all 10 patients had negative CTPA.
This subsegment of high-risk patients who could possibly avoid CTPA without missing important clinical findings needs to investigated further with larger dataset.