Association of Lower Diagnostic Yield With High Users of CT Pulmonary Angiogram

Abstract

Pulmonary embolism (PE) can be life-threatening and, when suspected, is usually investigated by computed tomographic pulmonary angiogram (CTPA). Concerns related to overutilization and harmful ionizing radiation have identified CTPA as an area in need of resource stewardship. 1,2 The purpose of this study was to explore interphysician variability in CTPA diagnostic yield and to identify any associated physician characteristics that could inform an intervention to reduce overuse in our institution.Methods | We retrospectively reviewed all CTPAs at an academic teaching hospital in Montreal, Quebec, Canada, from September 2014 to January 2016. Studies were classified as positive or negative; indeterminate examinations, and those performed for chronic pulmonary emboli were excluded. A total of 1394 examinations ordered by 182 physicians were included, of which 199 (14.3%) were positive and 1195 (85.7%) were negative. A multivariable logistic regression analysis was performed to explore whether physician specialty, years in practice, physician sex, or total numbers of studies ordered per physician were associated with CTPA diagnostic yield. We used a generalized estimating equations (GEE) approach to account for patients who underwent repeated examinations over the study period. 3 Statistical tests of hypothesis were 2-sided with a significance of P ≤ .05. All analyses were performed using SAS statistical software (version 9.4, SAS Institute Inc). The McGill University Health Centre research ethics board approved this study.

Yield of CT pulmonary angiography in the diagnosis of acute pulmonary embolism: short report

“…In comparison, all low-yield studies were from the US, raising the possibility that decreased CTPA yields in US medical centers could reflect concern for malpractice litigation, as was suggested by previous authors [2, 5]. Of note, a recent study of Sharma and Lucas from Scotland [6] shows a positive yield of CTPA for PE over 10%, like ours and another study conducted in another academic center in Canada [7].…”

Outcomes of Multidetector Computed Tomography Pulmonary Angiography in Pregnant and Postpartum Women With Suspected Pulmonary Embolism

“…34 Our overall CTPA diagnostic yield is also in line with the expected literature diagnostic yield of up to 15.3%. 35,36 Computed tomography pulmonary angiography diagnostic yield in pregnant women was much lower than in nonpregnant and postpartum patients, but comparable to the literature (2%-5%). 10,25,27 In our study, while pregnant patients underwent lower leg Doppler US more frequently (15.5%) than both nonpregnant (7.2%) and postpartum patients (3.8%), the majority went directly to CTPA, most likely due to lack of Doppler US availability after regular work hours.…”

Utilization of serum D-dimer assays prior to computed tomography pulmonary angiography scans in the diagnosis of pulmonary embolism among emergency department physicians: a retrospective observational study

“…As the availability and ease of access of CTPA in emergency departments increased over the past two decades, so too did its utilization by emergency physicians [1][2][3][4]. This higher utilization has, over time and across different centres, been associated with substantially lower diagnostic yields [1,[4][5][6][7]. The mounting evidence thus suggests a phenomenon of overutilization of CTPA among physicians in general, and among ED physicians in particular [2,3,[8][9][10].…”