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Appropriateness of the Usage of CTPA in suspected Pulmonary Embolism
EP33170
Poster Title: Appropriateness of the Usage of CTPA in suspected Pulmonary Embolism
Submitted on 20 Oct 2020
Author(s): Khoren Abelian, Omobolaji Ismail Akano, Sarah O'Brien, Apam Chiphang
Affiliations: Southport and Ormskirk NHS Foundation Trust
This poster was presented at BIR Annual Congress 2020
Poster Views: 493
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Poster Information
Abstract: Objectives
To assess
■ Utilisation of CTPA in PE.
■ CTPA diagnostic yield in terms of PE & alternative Dx.
■ Adherence to local Hospital protocol.

Methodology
Retrospective audit was performed using the PACS computer information system.
70 Patients who had a CTPA over a two-month period (June & July 2020) were identified from the radiology records . The collected data included : patients' demographic data,Referral source,Clinical referral information including (Wells score & D-dimer), CXR findings and CTPA test result .
Standarts: iRefer Guidelines
■ CTPA should be used to investigate suspected PE & CXR should be the preliminary investigation/target 100%
■ Referral should be in line with agreed local protocol for referral/target 100%.
■ CTPA should detect PE in at least 15%, with alternate diagnoses in at least a further 50%.

Results:
Wells score : written in 38% of the requests
D-dimer: in 50% of the patients, it was not done appropriately. PE: detected in 18% of the cases , mainly inpatient 63%
Alternative DX: mainly background lung disease, consolidation and effusion
Conclusion:
The local policy was not strictly adhered. Well's score had been mentioned in only 1/3 of patients and D-dimer been inappropriately conducted in 50%. PE rate was at the lower accepted level (18%) with acceptable rate of alternative dx.
Summary: This audit aims to assess the local practice against the iRefer guidelines for CTPA in suspected PE. To improve the diagnostic yield of CTPA, risk stratification criteria, involving Wells score and D-dimer have been usedReferences: 1. The Royal College of Radiologists. Suspected Pulmonary
Embolism (PE) Referral Guidelines

2. Appropriateness of usage of computed tomography pulmonary angiography (CTPA) investigation of suspected pulmonary embolism. Royal college of radiologists/Audit Live
https://www.rcr.ac.uk/audit/appropriateness-usage-computed-tomography-pulmonary-angiography-ctpa-investigation-suspected.


3. NICE Guidelines, approach to non massive Pulmonary Embolism
https://www.nice.org.uk/guidance/ng158/chapter/Recommendations#diagnosis-and-initial-management
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