Type:
Educational Exhibit
Keywords:
Performed at one institution, Not applicable, Retrospective, Embolism / Thrombosis, Audit and standards, CT-Angiography, Respiratory system, Pulmonary vessels, Emergency, Emergency Imaging
Authors:
N. Mirajkar1, G. Rowe2; 1Birmingham/UK, 2Herefordshire/UK
DOI:
10.26044/ecr2020/C-07905
Conclusion
- Positive detection rate (15%) and alternate diagnosis rate (31%) below the RCR recommendation.
- Only 15% of requests provided both a Wells score and d-dimer result with 34% of requests providing neither.
- Raising of the locally agreed d-dimer cut-off from 250 to 500 would not have resulted in any missed cases.
- Using the age adjusted d-dimer cut-off is highly sensitive.
- 38% of requests were deemed inadequate or incomplete based on the clinical details provided to justify a CTPA. All of these requests were negative for PE.
Following this audit, the local referral guidelines were refined and a more robust vetting system was instigated to avoid inappropriate scans. The use of age-adjusted d-dimer continues to be evaulated with the hope that this will be incorperated in future guidelines.
A further 100 PE positive cases with a documented d-dimer result are being analysed to assess the sensitivity/specificity of an unadjusted d-dimer cut-off (>500) vs the age adjusted d-dimer. Results of this are pending. A re-audit following the changes implented is ongoing in Feb/March 2020.