Congress:
EuroSafe Imaging 2020
Keywords:
Performed at one institution, Observational, Retrospective, Embolism / Thrombosis, Audit and standards, CT-Angiography, Conventional radiography, Pulmonary vessels, Lung, Emergency, Action 1 - Guidelines, implementation policies, and Clinical Decision Support (ESR iGuide)
Authors:
M. Al-Mahtot, N. McCarville, A. Tighilt, K. Luckyram, D. Hakim, P. Bamania
DOI:
10.26044/esi2020/ESI-09704
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 (44.6%) were abnormal, with 215 (55.4%) normal. Of the 482 patients sampled, 73 (15.15%) had a positive finding for PE, 407 (84.4%) had a negative finding for PE and 2 (0.41%) had unascertained findings for PE on the CTPA scan. Of the patients with CTPA scans that were positive for PE (73), 29 (39.7%) had abnormal chest x-ray findings, and so would not have been suitable for VQ scan, 29 (39.7%) had normal chest x-rays, and 15 (20.5%) had no chest x-ray prior to CTPA. Of those PE-positive CTPA scans, 36 (49.3%) had a positive Wells score provided, while 37 (50.7%) had either a negative Wells score or not Wells score provided at all. This displays that calculation of Wells score by clinicians is very operator dependant, and that they were unable to reliably determine which patients were high, moderate and low risk for PE using the Wells score.
Based on the results we have proposed the following:
1. Chest radiographs must be performed in all cases of suspected PE prior to CTPA.
2. As we have displayed variation in the ability of doctors to reliably distinguish high, moderate and low clinical probabilities of PE in patients, a d-dimer should be performed prior to all CTPA requests.
3. CTPA request forms will be modified such that there are mandatory fields to provide Wells score, d-dimer value and chest x-ray results.
4. Staff education will be provided through teaching sessions and/or an e-learning module for all doctors as well as posters on investigation of PE through imaging.
5. Upon successfully implementing these interventions, we will re-audit in 2020 in order to ascertain whether an improvement in requesting has been achieved.