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
Findings and procedure details
Audit Standards:
- Referrals should be in line with agreed local protocol for referral.
- According to published studies conducted at regional centres CTPA should detect pulmonary emboli in between 15.4 & 37.4% of patients, with alternate diagnoises noted in upto 56%2.
- All requests should have a documented Wells score, d-dimer result and adequate clinical history.
Target
1. 100%
2. 100%
3. Pulmonary emboli in at least 15%, with alternate diagnoses in at least a further 50%.
Data items collected:
1. Patient age and gender
2. Referral source (department)
3. Time of day the scan was performed (out-of-hours vs in-hours)
4. Documented Wells score and d-dimer result
5. Whether the age adjusted d-dimer cut-off was met
6. Clinical referral information and adherence to local protocol
7. Whether a preceeding CXR was performed
8. Positive findings of CTPA scan
9. Alternative diagnoses
100 consecutive CTPA examinations were included in the audit.
Results
Gender |
Frequency |
Male |
39 |
Female |
61 |
Age range |
Frequency |
18-30 |
6 |
31-50 |
13 |
51-70 |
34 |
71-90 |
40 |
90+ |
7 |
Fig. 2: Results 1 - Referral source & PE detection rate in/out of hours
Fig. 3: Results 2 - CTPA detection rate and documentation of Wells + D-dimer score
Fig. 4: Results 3 - Wells score and D-dimer breakdown
Fig. 5: Results 4 - Sensitivity/Specificity table for age adjusted d-dimer
83 requests had a prior chest x-ray within 48 hours prior to the CTPA scan. 17 requests had no prior chest x-ray.
In the 15 PE positive cases, 7 requests had documented d-dimer (all scores >1000), 3 requests had a Wells score documented (all >5), 1 requests had both a d-dimer and Wells score recorded and 4 requests had neither score recorded.