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Appropriateness of usage of CTPA in investigation of suspected pulmonary embolism
EP34227
Poster Title: Appropriateness of usage of CTPA in investigation of suspected pulmonary embolism
Submitted on 26 Oct 2020
Author(s): Mohammed Balal, Susan Geary
Affiliations: King’s Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust
Poster Views: 558
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Poster Information
Abstract: CTPA is the gold-standard imaging technique for diagnosing suspected pulmonary embolism.

This audit aims to assess, when being used as the primary imaging investigation, whether CTPA is being used appropriately; and also to look at the diagnostic yield of CTPA scans in terms of pulmonary emboli and alternative diagnoses.

Standards
1. CTPA should be used to investigate suspected pulmonary embolism
2. Recent CXR within 7 days
3. Referrals should be in line with agreed local protocol for referral
4. CTPA should detect pulmonary emboli in between 15.4 & 37.4% of patients, with alternate diagnoses noted in up to 56%.

Methods
Using the CRIS reporting system we analysed 50 consecutive CTPA reports issued in December 2019 (Audit) and June 2020 (Re-Audit).

Results

CTPA was the investigation of choice in 100% of cases
95% had preceding CXR within 7 days (from 82%)
Well’s score included in 34% of requests (increased from 28%)
Appropriate use of d-dimer 22% (from 6%)
PE detected in 18% cases (from 12%)
Alternative diagnosis in 56% of patients (from 48%)
Local protocol adhered to in 18% cases (from 22%)

Action plan:
Re-educate clinicians about local protocol
Introduce new request form which makes a Wells score a prerequisite for ordering a CTPA.

Conclusion
Current practice at KMH is in line with RCR standards both in terms of the minimum PE detection rate and alternate diagnoses reached. However, there’s a lack of adherence to local and RCR policy for requesting CTPA’s, with the majority of cases not including a calculated Wells’ score.
Summary: This audit aims to assess, when being used as the primary imaging investigation, whether CTPA is being used appropriately; and also to look at the diagnostic yield of CTPA scans in terms of pulmonary emboli and alternative diagnoses.References: iRefer / Making best use of a Department of Clinical Radiology, Guidelines for Doctors, Seventh Edition 2012, The Royal College of Radiologists, London.
Mos IC, Klok FA, Kroft LJ, DE Roos, Dekkers OM and Huisman MV. Safety of ruling out acute pulmonary embolism by normal computed tomography pulmonary angiography in patients with an indication for computed tomography: systematic review and meta-analysis. J Thromb Haemost. 2009 Sep;7(9):1491-8. Epub 2009 Jun 22.
Venous thromboembolic disease; the management of venous thromboembolic diseases and the role of thrombophilia testing, 2012. Nice guideline GC144
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