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Diagnosing Pulmonary Embolism: Where are we going wrong?
EP33141
Poster Title: Diagnosing Pulmonary Embolism: Where are we going wrong?
Submitted on 13 Oct 2020
Author(s): Miguel Jose Ribeiro da Costa, Syed Muhammad Hussaini, David Shackleton
Affiliations: Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, Twickenham Road, Isleworth, Middlesex, TW7 6AF
This poster was presented at BIR Annual Congress 2020
Poster Views: 117
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Poster Information
Abstract: Introduction

CTPA is the primary imaging technique for assessment of suspected pulmonary embolism (PE). CTPA is costly and involves high levels of radiation exposure. NICE provides a diagnostic framework, using Wells score, to manage patients with suspected PE.

Aim

This audit aims to Improve the pulmonary emboli diagnostic yield of CTPA scans in a West London District Emergency Department (ED) by improving NICE guidance adherence. According to published studies conducted at regional centres CTPA should detect Pulmonary emboli in at least 15% of patients.

Methods

Retrospective data for all CTPA scans was requested by the ED from 1st – 31st March 2019. The requests were examined and details of the Wells score and D-dimers were reviewed. A CTPA diagnostic result was recorded.
After the initial Audit Educational posters and education sessions for both Doctors and nurses were implemented. The re-audit cycle was completed by collecting data from 1st - 30th June 2020.

Results

50 CTPAs were carried out in the ED during March 2019. 10% patients were diagnosed with PE. Re-audit data from June 2020 where 49 CTPAs were carried out, demonstrated a 63% Increased yield in the number of PE observed to 16.3%.

The improvement was secondary to decreasing the number of inappropriate D-dimers requested in triage and increasing Wells score calculations.

Conclusions

Improving NICE guidance adherence on CTPA requesting has shown significant increase in the diagnostic yield of CTPA scans in terms of PE which equates to a decrease in unnecessary exposure to radiation and a noteworthy cost saving.
Summary: CTPA is the primary imaging technique for assessment of suspected pulmonary embolism (PE). NICE provides a diagnostic framework, using Wells score, to manage patients with suspected PE. A closed loop audit was conducted at a West London District Emergency Department (ED) to improve NICE guidance adherence and the PE diagnostic yield of CTPA scans. References: 1) https://www.nice.org.uk/guidance/ng158.
2) https://www.rcr.ac.uk/audit/appropriateness-usage-computed-tomography-pulmonary-angiography-ctpa-investigation-suspected
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