Posters
« Back
Appropriateness of usage of computed tomography pulmonary angiography (CTPA) for investigation of suspected pulmonary embolism
EP34288
Poster Title: Appropriateness of usage of computed tomography pulmonary angiography (CTPA) for investigation of suspected pulmonary embolism
Submitted on 28 Oct 2020
Author(s): F Ashraf, S Iyengar
Affiliations: Frimley Health NHS Foundation Trust
This poster was presented at BIR Annual Congress
Poster Views: 365
View poster »


Poster Information
Abstract: Background

Pulmonary embolism is an important disease with significant mortality and morbidity. The gold standard investigation for PE is the CTPA which has been shown to successfully exclude it given a good quality scan. There are good clinical scoring systems which have been externally validated that can help to guide the workup for patients with a suspected PE, these include the two-level Wells score and the PERC score (1). These clinical tools are useful in ensuring the best allocation of resources and minimising unnecessary investigation. Furthermore, NICE recommends the use of a 2 level Wells score in the assessment of PE.

Methods

The clinical notes and scans of 200 consecutive patients (13/11/2019- 31/12/2019), whom were investigated for PE with a CTPA, were retrospectively analysed. We looked to determine if a 2 level wells score or PERC score had been documented, the positive yield of the CTPA scans, whether a chest x-ray was taken prior to the CTPA and whether the CTPA had identified alternative pathology in those scans which were negative for PE. Where a Wells score or PERC score was not documented, one was calculated using the clinical notes. The results were then collated and analysed in Microsoft Excel.

Results

PE was found in 42 scans giving a positive yield of 21%. A Wells score was documented in 20 (10%) patients and a PERC score was not documented in any of the notes reviewed. 7 out of 200 patients had a low pre-test probability (Wells score ≤ 4) and a negative D-Dimer and all 7 patients had a negative CTPA for PE. 14 patients had a PERC score of 0 and all had negative CTPAs for PE. 95 (62%) out of the 158 negative CTPAs had an alternative clinically significant pathology identified by the CTPA. Of the 42 patients who had a positive CTPA half had an abnormal chest x-ray prior to the scan.

Conclusion/ implications/ recommendations

The positive yield of CTPA scans for PE is 21%, this is in line with the Royal College of Radiologist recommendations of between 15.4 & 37.4% of patients (2). This yield is improved when compared to a similar audit done in 2014/15 at Wexham Park Hospital which found a yield of 16.8% (3). 7 or 14 CTPA scans out of 200 could have been avoided had a 2 level Wells score or PERC score been used respectively. Interestingly 50% of the patients who had a PE also had an abnormal chest x-ray prior to the CTPA. As such, an abnormal chest x-ray should not be used to reduce the suspicion of PE which has traditionally been the teaching and often a reason for a CTPA scan being declined by the radiologist. To further improve the diagnostic yield of CTPAs and minimise avoidable scans a 2 level wells score could be incorporated into the computer request for CTPA on the ICE system as a compulsory input with a bypass for emergencies. Most of the avoidable scans were requested by clinicians working either in AECU or medicine, a teaching session could be incorporated into departmental inductions for these areas or a poster could be placed in the ED hub and AECU to advise using a clinical decision making tool.
Summary: NICE recommends the use of a 2 level Wells score in the assessment of PE, additional scoring tools exist such as the PERC tool. The clinical notes and scans of 200 consecutive patients whom were investigated for PE with a CTPA, were analysed. The positive yield of CTPA scans for PE was 21%, this is in line with the Royal College of Radiologist recommendations of between 15.4 & 37.4% (1). This yield is improved compared to a similar audit done in 2014/15 where the yield was 16.8% (2). References: 1. Singh B, Mommer SK, Erwin PJ, Mascarenhas SS, Parsaik AK. Pulmonary embolism rule-out criteria (PERC) in pulmonary embolism--revisited: a systematic review and meta-analysis. Emerg Med J. 2013 Sep;30(9):701-6. doi: 10.1136/emermed-2012-201730. Epub 2012 Oct 4. PMID: 23038695.

2. www.rcr.ac.uk. (n.d.). Appropriateness of usage of computed tomography pulmonary angiography (CTPA) investigation of suspected pulmonary embolism. | The Royal College of Radiologists. [online] Available at: https://www.rcr.ac.uk/audit/appropriateness-usage-computed-tomography-pulmonary-angiography-ctpa-investigation-suspected.

3. Mogal, R. and Pinto, C. (2016). Usage of computed-tomography pulmonary angiogram (CTPA) for suspected pulmonary embolism by adherence to National Institute for Health and Care Excellence (NICE) guidelines. European Respiratory Journal, [online] 48(suppl 60). Available at: https://erj.ersjournals.com/content/48/suppl_60/PA2472


Report abuse »
Questions
Ask the author a question about this poster.
Ask a Question »

Creative Commons

Related Posters


Screen hours, Room, Number of Gadgets and Their Relation to Sleep Quality among Allied Health Students Enrolled in Online Class
Chew, Carol; Adap, Joyce Ann; Balmes, Joshua Angelo; Basilio, Iva Kolin; Dela Pedra, Myrra Mae; Escabarte, Carlos Jose; Zamora, Maybelle Anne

MUSCULOSKELETAL SYMPTOMS AND ASSOCIATED RISK FACTORS INCOLLEGE STUDENTS UNDERTAKING ONLINE LEARNING
Manaeg, Shannen; Dela Cruz, Aaron Paul Gabriel, Dela Cruz; Jose Angelo; Fabricante, Ira May; Manguiat, Janesia Kryssle; Santos, Ronan Ezra; Fernandez-Tiongco, Angelica

CERVICAL FIBROID PARODYING AS VAGINAL PROLAPSE
DR GEETANJALI KRISHNAN, DR SATHYA BALASUBRAMANIAM

Developing a robust Quantitative Systems Pharmacology model of adeno-associated virus (AAV) based gene therapy for clinical applications
Satyajit Rao, Jatin Narula, Zhiwei Zhang, Haobin Luo, Glen Ko, Cynthia J Musante, Nessy Tania

ISTHMOCELE A RECAP
DR RAJASRI,DR GEETANJALI