Automated Pulmonary Embolism Risk Classification and Guideline Adherence for Computed Tomography Pulmonary Angiography Ordering

Simon, Emma; Horwitz, Leora I.; Makarov, Danil V.; Smith, Silas W.; Jones, Simon; Gyftopoulos, Soterios; Swartz, Jordan

doi:10.1111/acem.13442

Cited by 3 publications

(3 citation statements)

References 32 publications

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“…At our institution, although users of a CDS tool incorporating the Wells score had CTPA yields of 38% higher than nonusers, the tool was dismissed in 65% of the cases [13]. Rather than requiring burdensome review of fragmented clinical data [14][15][16] and manual input of score components by providers, a CDS tool that presents a Wells score automatically calculated from existing EHR data could improve efficiency and usability and thereby tool acceptance [17,18].…”

Section: Introductionmentioning

confidence: 95%

Automated Pulmonary Embolism Risk Assessment Using the Wells Criteria: Validation Study (Preprint)

Zhang¹,

Rameau²,

Julemis³

et al. 2021

Preprint

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BACKGROUND Computed tomography pulmonary angiography (CTPA) is frequently used in the emergency department (ED) for diagnosis of pulmonary embolism (PE), while posing risk for contrast-induced nephropathy and radiation-induced malignancy. OBJECTIVE We aimed to create an automated process to calculate the Well’s Score for Pulmonary Embolism for patients in the ED, which could potentially reduce unnecessary CTPA studies. METHODS We designed an automated process using electronic health records (EHR) data elements, including using a combinatorial keyword search method to query free-text fields, and calculated automated Well’s Scores for a sample of all adult ED encounters that resulted in a CTPA study for PE at two tertiary care hospitals in New York over a two-month period. To validate the automated process, scores were compared to those derived from a two-clinician chart review. RESULTS A total of 202 ED encounters resulted in a completed CTPA to form the retrospective study cohort. Patients classified as “PE likely” by the automated process had a PE prevalence of 15.9%, whereas those classified as “PE unlikely” (Wells’ Score 4) had a PE prevalence of 7.9%. With respect to classification of the patient as “PE likely,” the automated process achieved an accuracy of 92.1% when compared chart review, with sensitivity, specificity, positive predictive value and negative predictive value of 93%, 90.5%, 94.4%, and 88.2% respectively. CONCLUSIONS This was a successful development and validation of an automated process using EHR data elements, including free-text fields, to classify risk for PE in ED visits.

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Section: Introductionmentioning

confidence: 95%

Automated Pulmonary Embolism Risk Assessment Using the Wells Criteria: Validation Study (Preprint)

Zhang¹,

Rameau²,

Julemis³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…At our institution, although users of a CDS tool incorporating the Wells score had CTPA yields of 38% higher than nonusers, the tool was dismissed in 65% of the cases [ 13 ]. Rather than requiring burdensome review of fragmented clinical data [ 14 - 16 ] and manual input of score components by providers, a CDS tool that presents a Wells score automatically calculated from existing EHR data could improve efficiency and usability and thereby tool acceptance [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…Previous analysis of the Wells score concluded that it is less amenable to automatic calculation due to the inclusion of variables that either require clinical gestalt (PE as or more likely than alternative diagnosis) or are likely to be embedded in unstructured data (clinical signs and symptoms of deep venous thrombosis [DVT] and hemoptysis) [ 19 ]. Yet, using narrow definitions of the Wells score components based only on structured data can lead to decreased sensitivity for relevant clinical documentation [ 17 ]. The objective of our study was to design an automated process that incorporates information from unstructured data, and to validate its accuracy.…”

Section: Introductionmentioning

confidence: 99%

Automated Pulmonary Embolism Risk Assessment Using the Wells Criteria: Validation Study

Zhang¹,

Rameau²,

Julemis³

et al. 2022

JMIR Form Res

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Background Computed tomography pulmonary angiography (CTPA) is frequently used in the emergency department (ED) for the diagnosis of pulmonary embolism (PE), while posing risk for contrast-induced nephropathy and radiation-induced malignancy. Objective We aimed to create an automated process to calculate the Wells score for pulmonary embolism for patients in the ED, which could potentially reduce unnecessary CTPA testing. Methods We designed an automated process using electronic health records data elements, including using a combinatorial keyword search method to query free-text fields, and calculated automated Wells scores for a sample of all adult ED encounters that resulted in a CTPA study for PE at 2 tertiary care hospitals in New York, over a 2-month period. To validate the automated process, the scores were compared to those derived from a 2-clinician chart review. Results A total of 202 ED encounters resulted in a completed CTPA to form the retrospective study cohort. Patients classified as “PE likely” by the automated process (126/202, 62%) had a PE prevalence of 15.9%, whereas those classified as “PE unlikely” (76/202, 38%; Wells score >4) had a PE prevalence of 7.9%. With respect to classification of the patient as “PE likely,” the automated process achieved an accuracy of 92.1% when compared with the chart review, with sensitivity, specificity, positive predictive value, and negative predictive value of 93%, 90.5%, 94.4%, and 88.2%, respectively. Conclusions This was a successful development and validation of an automated process using electronic health records data elements, including free-text fields, to classify risk for PE in ED visits.

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Efficacy and Impact of a Multimodal Intervention on CT Pulmonary Angiography Ordering Behavior in the Emergency Department

Gyftopoulos¹,

Simon²,

Swartz³

et al. 2024

Journal of the American College of Radiology

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Automated Pulmonary Embolism Risk Classification and Guideline Adherence for Computed Tomography Pulmonary Angiography Ordering

Cited by 3 publications

References 32 publications

Automated Pulmonary Embolism Risk Assessment Using the Wells Criteria: Validation Study (Preprint)

Automated Pulmonary Embolism Risk Assessment Using the Wells Criteria: Validation Study (Preprint)

Automated Pulmonary Embolism Risk Assessment Using the Wells Criteria: Validation Study

Efficacy and Impact of a Multimodal Intervention on CT Pulmonary Angiography Ordering Behavior in the Emergency Department

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