Imaging for the clinician special sectionClinical research studyAdherence to PIOPED II Investigators' Recommendations for Computed Tomography Pulmonary Angiography
Section snippets
Study Site and Population
Intermountain Medical Center is a university-affiliated tertiary medical center in Murray, Utah, and LDS Hospital is a community hospital in Salt Lake City, Utah. In 2009 and 2010, emergency department visits exceeded 83,000 and 25,000, respectively. The Intermountain Healthcare Institutional Review Board approved this Health Insurance Portability and Accountability Act-compliant study and waived written informed consent. We queried the Intermountain Healthcare Enterprise Data Warehouse and
Sample and Patient Characteristics
The reports of 5220 consecutive chest CT scans ordered from the 2 emergency departments were reviewed to identify 3500 consecutive CT pulmonary angiograms ordered between May 22, 2009, and June 30, 2010, for suspected pulmonary embolism. A total of 2755 (78.7%) CT pulmonary angiograms were performed at Intermountain Medical Center, and 745 (21.3%) CT pulmonary angiograms were performed at LDS Hospital.
Table 1 shows the clinical characteristics for all patients and subgroups prespecified by
Discussion
We found that more than half of 3500 CT pulmonary angiograms performed to investigate clinically suspected acute pulmonary embolism were not concordant with recommendations of the PIOPED II investigators. There are several possible explanations for the disparity we observed between practice and published recommendations. First, 95% of patients who underwent CT pulmonary angiography for suspected pulmonary embolism had a pretest probability of “pulmonary embolism unlikely” (RGS ≤ 10). Most
Conclusions
CT pulmonary angiogram examinations are often not concordant with expert recommendations and guidelines for investigation of suspected pulmonary embolism. Emergency department physicians order many CT pulmonary angiograms when pulmonary embolism is unlikely and sensitive D-dimer test results are negative. This practice lowers the diagnostic yield of CT pulmonary angiograms and exposes some patients to risks associated with CT pulmonary angiography, including false-positive test results and
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Robert G. Stern, MD, Section Editor
Funding: Supported in part by the North American Thrombosis Forum Traveling Fellowship.
Conflict of Interest: None.
Authorship: All authors had access to the data and played a role in writing this manuscript.