Effect of Computerized Clinical Decision Support on the Use and Yield of CT Pulmonary Angiography in the Emergency Department

Raja, Ali S.; Ip, Ivan K.; Prevedello, Luciano M.; Sodickson, Aaron; Farkas, Cameron; Zane, Richard D.; Hanson, Richard W.; Goldhaber, Samuel Z.; Gill, Ritu R.; Khorasani, Ramin

doi:10.1148/radiol.11110951

Cited by 217 publications

(152 citation statements)

References 23 publications

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“…Quality improvement projects are needed to encourage physicians to adhere to the current guidelines. A possible method to encourage physicians to adhere to the current guidelines is the use of evidence-based clinical decision support reminders as part of the electronic medical record to remind physicians about the importance of D-dimer assay in the low PCTP group [21]. …”

Section: Resultsmentioning

confidence: 99%

Computed tomography pulmonary angiography is overused to diagnose pulmonary embolism in the emergency department of academic community hospital

Osman

Subedi

Ahmed

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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Background: Pulmonary embolism (PE) is a common disease in the USA responsible for up to 10% of hospital mortality. Modified wells score (MWS) and D-dimer assay are used to categorize patients into high or low probability of PE. Patient with high probability need Computed tomography pulmonary angiography (CTPA), while patients with low probability and low D-dimer can safely forgo the CTPA. Objectives: The aim of this study was to investigate the rate of inappropriate CTPA use in the emergency department of a community teaching hospital. Methods: A retrospective chart review of adult patients who underwent CTPA for suspected PE in the emergency department for 2015 was done. CTPA use was considered inappropriate if MWS was less than or equal to 4 and D-dimer was either not ordered or its value was less than 500 μg/L. Bivariate analysis with Fisher’s exact tests and Student’s t-tests as well as multivariate logistic regression analysis were done to examine relationship between study explanatory variables and study outcome. Results: 295 patients were included in the study. The mean age was 51.2(±14.5) years, 68.8% were females. The prevalence of PE was 5.4% and 41% of the CTPAs -were inappropriately ordered. Males were twice (OR 2.1; 95% CI 1.2, 3.6) as likely as females to have an inappropriately ordered CTPA after controlling for a high MWS, age, and tobacco history. Conclusion: CTPA is overused to diagnose PE in the emergency department. Quality improvement projects are needed to encourage physicians to adhere to the current guidelines.

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Section: Resultsmentioning

confidence: 99%

Computed tomography pulmonary angiography is overused to diagnose pulmonary embolism in the emergency department of academic community hospital

Osman

Subedi

Ahmed

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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“…After lung cancer diagnosis, Sesen et al demonstrated the use of a Bayesian network decision support system for personalized survival estimates and treatment selection recommendations in lung cancer [8]. While not directly comparable to lung nodule screening, evidence-based clinical decision support tools have also been effective in decreasing the overutilization of CT while increasing yield of the studies performed for CT pulmonary angiography [9].…”

Section: Introductionmentioning

confidence: 99%

Data-Driven Decision Support for Radiologists: Re-using the National Lung Screening Trial Dataset for Pulmonary Nodule Management

et al. 2014

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Real-time mining of large research trial datasets enables development of case-based clinical decision support tools. Several applicable research datasets exist including the National Lung Screening Trial (NLST), a dataset unparalleled in size and scope for studying population-based lung cancer screening. Using these data, a clinical decision support tool was developed which matches patient demographics and lung nodule characteristics to a cohort of similar patients. The NLST dataset was converted into Structured Query Language (SQL) tables hosted on a web server, and a web-based JavaScript application was developed which performs realtime queries. JavaScript is used for both the server-side and client-side language, allowing for rapid development of a robust client interface and server-side data layer. Real-time data mining of user-specified patient cohorts achieved a rapid return of cohort cancer statistics and lung nodule distribution information. This system demonstrates the potential of individualized real-time data mining using large highquality clinical trial datasets to drive evidence-based clinical decision-making.

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“…Quality measurement and feedback programs have become widespread and are often a significant portion of quality improvement efforts. While there is a large and growing body of literature regarding computerized imaging decision support and how it may be used to affect utilization, variation, and appropriateness, [9][10][11][12] there is unfortunately a paucity of research examining the effects of individual physician feedback on test-ordering metrics. While diagnostic imaging use has increased in the absence of demonstrable benefits, 13,14 an understanding of the reasons for this increase and how to change clinicians' behavior is needed.…”

mentioning

confidence: 99%

Medically Unnecessary Advanced Diagnostic Imaging and Shared Decision‐making in the Emergency Department: Opportunities for Future Research

Hess

Marin

Mills

2015

Academic Emergency Medicine

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Effect of Computerized Clinical Decision Support on the Use and Yield of CT Pulmonary Angiography in the Emergency Department

Abstract: Purpose:To determine the effect of evidence-based clinical decision support (CDS) on the use and yield of computed tomographic (CT) pulmonary angiography for acute pulmonary embolism (PE) in the emergency department (ED).

Cited by 217 publications

References 23 publications

Computed tomography pulmonary angiography is overused to diagnose pulmonary embolism in the emergency department of academic community hospital

Computed tomography pulmonary angiography is overused to diagnose pulmonary embolism in the emergency department of academic community hospital

Data-Driven Decision Support for Radiologists: Re-using the National Lung Screening Trial Dataset for Pulmonary Nodule Management

Medically Unnecessary Advanced Diagnostic Imaging and Shared Decision‐making in the Emergency Department: Opportunities for Future Research

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