CT Pulmonary Angiography: A Comparative Analysis of the Utilization Patterns in Emergency Department and Hospitalized Patients Between 1998 and 2003

Prologo, J. David; Gilkeson, Robert C.; Diaz, Mireya; Asaad, Joe

doi:10.2214/ajr.183.4.1831093

Cited by 113 publications

(57 citation statements)

References 39 publications

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“…Our analysis showed a static trend in use of CT pulmonary angiographic imaging before CDS implementation without a significant change in the use trend before and after implementation of CDS. This is contrary to previous reports of increasing use of CT pulmonary angiographic imaging to evaluate patients suspected of having acute PE in both the ED (10,15,25) and inpatient settings (16). The static trend in use of CT pulmonary angiographic imaging before and after CDS at our institution may have been because of external and institution-specific factors, such as temporal changes in use of CT pulmonary angiographic imaging that were from increased emphasis within the medical literature and general media regarding the risks of medical radiation, increased knowledge of prediction rules to assess probability for acute PE, the effect of learning within our institution because of implementation of a similar CDS tool in our ED 27 months before the current study, and our institution's established culture of quality.…”

Section: Discussioncontrasting

confidence: 97%

“…A 12.3% decrease in monthly use of CT pulmonary angiography (26.0 to 22.8 CT pulmonary angiographic examinations per 1000 admissions before and after CDS, respectively; P = .008) observed 1 month after CDS implementation was sustained over the ensuing 32-month period. There was a nonsignificant 16.3% increase in monthly yield of CT pulmonary angiography or percentage of CT pulmonary angiographic examinations positive for acute PE after CDS (P = .65).…”

Section: Resultsmentioning

confidence: 87%

“…CT pulmonary angiographic imaging is the examination of choice to diagnose acute pulmonary embolism (PE) (14), and its use for this purpose is increasing in both ED and inpatient settings (10,15,16). Increase in use of CT pulmonary angiographic imaging has been Implication for Patient Care n Adoption of CDS on the basis of high-quality evidence can have an immediate and significant effect on the use of CT pulmonary angiographic imaging in the inpatient setting, with the potential to improve efficiency of care and reduce potentially unnecessary radiation exposure to patients.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Evidence-based Clinical Decision Support on the Use and Yield of CT Pulmonary Angiographic Imaging in Hospitalized Patients

Dunne¹,

Ip²,

Abbett³

et al. 2015

Radiology

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MPH Purpose:To determine the effect of clinical decision support (CDS) on the use and yield of inpatient computed tomographic (CT) pulmonary angiography for acute pulmonary embolism (PE). Materials and Methods:This HIPAA-compliant, institutional review board-approved study with waiver of informed consent included all adults admitted to a 793-bed teaching hospital from April 1, 2007, to June 30, 2012. The CDS intervention, implemented after a baseline observation period, informed providers who placed an order for CT pulmonary angiographic imaging about the pretest probability of the study based on a validated decision rule. Use of CT pulmonary angiographic and admission data from administrative databases was obtained for this study. By using a validated natural language processing algorithm on radiology reports, each CT pulmonary angiographic examination was classified as positive or negative for acute PE. Primary outcome measure was monthly use of CT pulmonary angiography per 1000 admissions. Secondary outcome was CT pulmonary angiography yield (percentage of CT pulmonary angiographic examinations that were positive for acute PE). Linear trend analysis was used to assess for effect and trend differences in use and yield of CT pulmonary angiographic imaging before and after CDS. Results:In 272 374 admissions over the study period, 5287 patients underwent 5892 CT pulmonary angiographic examinations. A 12.3% decrease in monthly use of CT pulmonary angiography (26.0 to 22.8 CT pulmonary angiographic examinations per 1000 admissions before and after CDS, respectively; P = .008) observed 1 month after CDS implementation was sustained over the ensuing 32-month period. There was a nonsignificant 16.3% increase in monthly yield of CT pulmonary angiography or percentage of CT pulmonary angiographic examinations positive for acute PE after CDS (P = .65). Conclusion:Implementation of evidence-based CDS for inpatients was associated with a 12.3% immediate and sustained decrease in use of CT pulmonary angiographic examinations in the evaluation of inpatients for acute PE.q RSNA, 2015

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Section: Discussioncontrasting

confidence: 97%

Section: Resultsmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Effect of Evidence-based Clinical Decision Support on the Use and Yield of CT Pulmonary Angiographic Imaging in Hospitalized Patients

Dunne¹,

Ip²,

Abbett³

et al. 2015

Radiology

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“…Some of these analyses have demonstrated a trend towards decreasing diagnostic yields (defined as the proportion of positive tests among all tests ordered). [8][9][10] To the best of our knowledge, there is no guidance for yield rates of emergent CT scan use in southern Africa and no acceptable standards have been set. Therefore, it is important to study the utilisation of CT scanning in the ED and to establish acceptable rates of positive yields to monitor the use of this valuable resource.…”

Section: Researchmentioning

confidence: 99%

High positive computed tomography yields in the emergency department might not be a positive finding

Swartzberg

Goldstein

2018

S Afr Med J

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Background. There is growing pressure to reduce unnecessary computed tomography (CT) imaging requests that the radiology department receives from the emergency department (ED); however, information on acceptable usage rates and diagnostic yields remains scanty. Objectives. To describe the indications, clinical categories and positive yield rates of patients receiving CT scans in the ED. Methods. A retrospective record review was done of all patients who received CT scans at an urban, adult academic ED during a 4-month period. Primary outcomes were to establish CT scan usage and positive yield rates. Other outcomes included analysis of indications, demographics and anatomical areas scanned. Results. Scans (n=1 010) were analysed. The median age of patients was 36 (range 4 -93) years. Male patients received 64.3% of all scans, as well as 75.7% of the scans performed for trauma. The majority of the scans were for trauma patients. However, non-trauma patients had a higher positive yield; the non-trauma positive yield rate was 61.8% compared with the trauma positive yield rate of 47.1% (p<0.001). The majority of scans performed were of the head (58%) and neck (20%), with lowest positive yield rates of 48.9% and 17%, respectively. The overall CT scan usage rate was 4.6% and overall positive rate 53.8%. Conclusion. A negative CT scan does not necessarily mean that the test was not indicated. Higher positive yield rates may reflect insufficient use of CT scanning by the ED. Local guidelines should be established to ensure judicious and effective clinical use of CT scans.

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“…The value of CT in diagnosing PE after applying CDRs has been evaluated in many studies (41). The largest study to date was PIOPED II (824 patients), where Wells score and CTPA results were compared with V/Q imaging, invasive pulmonary angiography or ultrasonography for DVT (23).…”

Section: Main Pointsmentioning

confidence: 99%

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Doğan

A²,

Geleijins³

et al. 2015

Diagn Interv Radiol

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A cute pulmonary embolism (PE) is the third most common cardiovascular condition, after coronary artery disease and stroke (1). Due to lack of specific sets of symptoms that accurately predict or exclude the diagnosis of acute PE, the diagnosis strongly relies on noninvasive imaging techniques. Diagnostic strategies for evaluating PE have undergone important changes over the past decades (2). Due to rapid technical advances in speed and spatial resolution, the utility of computed tomography (CT) angiography has been recognized in vascular imaging. Particularly, after the development of multidetector row CT in 1998 (3), CT pulmonary angiography (CTPA) has become the imaging method of choice in the diagnosis of acute PE (4). CTPA has advantages over conventional invasive X-ray pulmonary angiography and nuclear ventilation-perfusion (V/Q) imaging. CT is a widely available, fast and noninvasive technique, has the capability to directly visualize emboli, and may provide alternative diagnoses (4).Despite adequate diagnosis and anticoagulant therapy, death rate after a diagnosis of acute PE is still 8%-15% (5, 6). The prognosis of acute PE mainly depends on residual pulmonary circulation and the severity of right ventricular (RV) dysfunction (7). Recent studies have shown that CT permits the assessment of acute right-sided heart failure. Furthermore, CT can predict adverse clinical outcome by using the RV/left ventricular (LV) diameter ratio (8, 9) or RV ejection fraction in patients with PE (10).The aim of this review is to discuss the developments of CT in PE diagnosis, and to analyze the added value of CT in estimating PE severity and prognosis. Furthermore, CT findings of chronic thromboembolic pulmonary arterial hypertension (CTEPH) as a complication of acute PE will be discussed. CT developments in PE diagnosisHistorically, pulmonary angiography and nuclear planar V/Q-imaging were the main imaging methods used for diagnosing PE. Both methods have recognized limitations. Pulmonary angiography has previously been regarded as reference standard, but the method CHEST IMAGING REVIEW ABSTRACT Pulmonary embolism (PE) is a potentially life threatening condition requiring adequate diagnosis and treatment. Computed tomography pulmonary angiography (CTPA) is excellent for including and excluding PE, therefore CT is the first-choice diagnostic imaging technique in patients suspected of having acute PE. Due to its wide availability and low invasiveness, CTPA tends to be overused. Correct implementation of clinical decision rules in diagnostic workup for PE improves adequate use of CT. Also, CT adds prognostic value by evaluating right ventricular (RV) function. CT-assessed RV dysfunction and to lesser extent central emboli location predicts PE-related mortality in normotensive and hypotensive patients, while PE embolic obstruction index has limited prognostic value. Simple RV/left ventricular (LV) diameter ratio measures >1.0 already predict risk for adverse outcome, whereas ratios <1.0 can safely exclude adverse outcome. Con...

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CT Pulmonary Angiography: A Comparative Analysis of the Utilization Patterns in Emergency Department and Hospitalized Patients Between 1998 and 2003

Cited by 113 publications

References 39 publications

Effect of Evidence-based Clinical Decision Support on the Use and Yield of CT Pulmonary Angiographic Imaging in Hospitalized Patients

Effect of Evidence-based Clinical Decision Support on the Use and Yield of CT Pulmonary Angiographic Imaging in Hospitalized Patients

High positive computed tomography yields in the emergency department might not be a positive finding

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

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