Pulmonary embolism (PE) has an annual incidence of 78/10,000 in the UK1. CT pulmonary angiogram (CTPA) provides a sensitive and specific means of diagnosing PE, when supported by strong clinical judgement and the modified Wells score for PE (Figure 1) as outlined in the NICE guidance1. The modified Wells score provides a pre-test probability of the likelihood of PE2. NICE and BTS guidelines outline that a chest x-ray is useful prior to CTPA in ruling out alternative diagnoses3. Our local trust guidelines state this as...
Description of activity and work performed
Our aims in this project were to investigate:
1. Are chest x-rays being performed prior to CTPA scans in patients with suspected PE?
2. Is the Wells score provided on CTPA requests?
3. Is the d-dimer value provided on CTPA requests?
4. Of the patients with CTPA scans that are positive for PE, how many had chest x-rays with abnormal findings?
5. Of the patients with CTPA scans that are positive for PE, how many had positive Wells scores?
Using the CRIS system, we retrospectively...
Conclusion and recommendations
A total of 482 CTPA scans were performed on patients with suspected PE in St Peter’s Hospital between 1st June 2019 and 30th September 2019. Of those, 260 (53.94%) had a Wells Score noted on the request form, and 222 (46.06%) did not. 240 (49.8%) had a d-dimer noted on the request form, and 242 (51.2%) did not. Of the same cohort, 388 (80.50%) had a recent chest x-ray performed prior to a CTPA scan, whereas 94 (19.50%) did not. Of these chest x-rays, 173...
K. Luckyram; Chertsey, Surrey/UK - nothing to disclose M. Al-Mahtot; Chertsey, Surrey/UK - nothing to disclose N. McCarville; Chertsey, Surrey/UK - nothing to disclose A. Tighilt; Chertsey, Surrey/UK - nothing to disclose
1. NICE(2016)Venous thromboembolism in adults: diagnosis and management. Quality standard (QS29).National Institute for Health and Care Excellence.
2. Wells P, Anderson D, Rodger M et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2000; 83 (3): 416–420.
3. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism Thorax2003;58:470-483.
4. Pulmonary Embolism Pathway Algorithm, Ambulatory Emergency Care Pathways, Ashford and St Peter’s Hospitals NHS Foundation Trust.