Study setting & Patient assessment:

We conducted a retrospective chart review of Emergency Department (ED) encounters of adult patients who underwent CTPA at our institute from Mar 2016 to Mar 2017. 

Our institute is a large, 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 cohort were collected from our institutional electronic health records (EHR) database and Computerized Physician Order Entry (CPOE) system.Use of CPOE in clinical practice has been associated with improvements in medication safety, efficiency, physician ordering patterns  and cost reduction. Increasing the percentage of imaging orders clinicians place via CPOE yields important opportunities to expose them to decision support (DS), potentially reducing waste and improving quality of care. Upon entering a password-protected login, the physician creates orders for a specific study. Patients are identified by unique medical record numbers. CTPA order in CPOE was designed to capture all relevant information necessary to calculate Well's score (Fig.2).D-dimer values were taken from the EHR data base. Imaging data were identified using the radiology information system.

Inclusion criteria All adult patients with clinical suspicion of Pulmonary embolism who underwent CTPA

Exclusion criteria  included the patients who were allergic to contrast and Pregnant patients

Outcome Measures:

Primary outcome was discordance with the Modified Well's Score criteria .

Secondary outcome was number of deaths in Emergency Department(ED)

Data Analysis:

Patients were classified as PE Likely and PE unlikely based on the calculated Modified Well's Score

Depending on presence of pulmonary embolism, CTPA findings were classified as Positive or negative