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Audit, research and guideline update
Computerised clinical decision support for suspected PE
  1. David Jiménez1,
  2. Santiago Resano2,
  3. Remedios Otero3,
  4. Carolina Jurkojc1,
  5. Ana Karina Portillo4,
  6. Pedro Ruiz-Artacho5,
  7. Jesús Corres6,
  8. Agustina Vicente2,
  9. Paul L den Exter7,
  10. Menno V Huisman7,
  11. Lisa Moores8,
  12. Roger D Yusen9
  13. for the IRYCIS Pulmonary Embolism Study Group
    1. 1Respiratory Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, and Alcala de Henares University, Madrid, Spain
    2. 2Radiology Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
    3. 3Respiratory Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
    4. 4Department of Internal Medicine, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
    5. 5Emergency Department, Hospital Clínico, Madrid, Spain
    6. 6Emergency Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
    7. 7Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
    8. 8F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, USA
    9. 9Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
    1. Correspondence to David Jiménez Castro, Respiratory Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, and Alcala de Henares University, Madrid 28034, Spain; djc_69_98{at}yahoo.com

    Abstract

    This study aimed to determine the effect of an evidence-based clinical decision support (CDS) algorithm on the use and yield of CT pulmonary angiography (CTPA) and on outcomes of patients evaluated in the emergency department (ED) for suspected PE. The study included 1363 consecutive patients evaluated for suspected PE in an ED during 12 months before and 12 months after initiation of CDS use. Introduction of CDS was associated with decreased CTPA use (55% vs 49%; absolute difference (AD), 6.3%; 95% CI 1.0% to 11.6%; p=0.02). The use of CDS was associated with fewer symptomatic venous thromboembolic events during follow-up in patients with an initial negative diagnostic evaluation for PE (0.7% vs 3.2%; AD 2.5%; 95% CI 0.9% to 4.6%; p<0.01).

    • Pulmonary Embolism

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