Use of computed tomographic pulmonary angiography for the diagnosis of pulmonary embolism; are we overdoing it?

Abstract

BACKGROUND:

Computed tomographic pulmonary angiography (CTPA) is a gold standard test for the diagnosis of pulmonary embolism (PE), but is reported to be over prescribed. We performed this study to determine over prescription of CTPAs at a District General Hospital (DGH) in the United Kingdom. Our secondary aim was to establish a cause of its over-prescription.

METHODS:

We retrospectively reviewed clinical data of all patients who underwent CTPAs during January 2011 to July 2013. Collected data included CTPA findings, clinical probability score, D-dimer results, chest x-ray (CXR) findings and patient's demographic data. A calculation of overall clinical probability (including initial and post CTPA values) and its cross analysis with D-dimer, CTPA and CXR findings was made.

RESULTS:

Pulmonary embolism was positive in 5 (11.6%) cases. An Initial probability score was available in 16 (37.20%), and a D-dimer result was available in 33 (76.7%). Chest X-ray (CXR) was abnormal in 8 (18.6%). A coupling of total probability score with D-dimer results (CPPD) identified 10 (22.2%) potential over prescriptions. A further analysis of CPPD with CXR revealed a definite over prescription of 8 (18.6%), whereas it increased the number of an overall possible over prescription to 14 (32.6%).

CONCLUSION:

The CTPAs are being over prescribed and the main reasons behind it are poor utilization of probability scoring systems, D-dimer rule and lack of interpretation of alternative diagnosis on CXRs.

• Authors: Shahid Kalim, Muhammad Shakil Akhtar
• Journal: Journal of Ayub Medical College, Abbottabad : JAMC (J Ayub Med Coll Abbottabad) 2014 Jan-Mar Vol. 26 Issue 1 Pg. 76-9 ISSN: 1025-9589 [Print] Pakistan
• PMID: 25358224 (Publication Type: Journal Article)

Chemical References

• Fibrin Fibrinogen Degradation Products
• fibrin fragment D

Topics

• Adult
• Aged
• Angiography (methods, statistics & numerical data)
• Female
• Fibrin Fibrinogen Degradation Products
• Humans
• Male
• Middle Aged
• Pulmonary Embolism (diagnostic imaging)
• Retrospective Studies
• Tomography, X-Ray Computed (methods, statistics & numerical data)
• United Kingdom