RT Journal Article
SR Electronic
T1 P182 The appropriateness of the usage of ct pulmonary angiography for the diagnosis of pulmonary embolism; evaluation of the current practice at east kent hospitals university nhs foundation trust and review of similar studies
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP A180
OP A182
DO 10.1136/thoraxjnl-2017-210983.324
VO 72
IS Suppl 3
A1 Vrettos, A
A1 Prasinou, M
A1 Basit, R
A1 Malamis, D
YR 2017
UL http://thorax.bmj.com/content/72/Suppl_3/A180.2.abstract
AB Background Computed tomography of pulmonary angiogram (CTPA) is widely used for the diagnosis of patients with possible pulmonary embolism (PE). We sought to audit the positive yield of CTPAs performed in our Trust over a total of two months and compare our practice against accepted standards. The Royal College of Radiologist (UK) suggests 15.4%–37.4% as an acceptable CTPA positive rate. Studies auditing clinical practice in UK and non-UK hospitals were also reviewed.Methods The Results of a total of 236 CTPAs from Queen Elizabeth the Queen Mother Hospital in Margate and the William Harvey Hospital in Ashford were retrospectively reviewed. Patients’ baseline and clinical details as well d-dimer levels were retrospectively collected. Wells score was calculated for each patient based on the clinical notes. The documentation of pre-test probability score in the request forms was also assessed.Results The reported findings for the 236 CTPA scans were PE in 34 (14%) scans, significant pathology was detected in 53 (22%) scans, an alternative diagnosis was made in 54 (23%) and no abnormality was detected in 88 (37%) scans. Only 12 (5%) cases had clinical probability scores documented. The majority (68%) of patients with high Wells score had CTPA done without d-dimers testing. Our review of the literature showed that CPTA Results can vary considerably depending on the clinical setting from 6.6% for patients seen in A and E, to up to 31% for patients admitted in General Medicine with mean positive yield of 18.8%. The documentation of pre-test probability was also poor (between 0% and 24%). Results from UK teaching and non-teaching hospitals were similar.Conclusions Our regional clinical audit showed that our positive yield is lower than the recommended standards. We made good use of d-dimer testing when PE was suspected in patients with high pre-test probability. Adherence to current guidelines could increase the diagnostic yield and reduce costs and risks associated with CTPA scans. Extrapolated to a larger scale, this would translate into significant reduction in costs and risks associated with radiation and contrast exposure. Most of the reported clinical audits from UK hospitals revealed acceptable CTPA positive rates.View this table:Abstract P182 Table 1 Audit results