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The Appropriateness of Clinical Referrals for CTPA Investigation at Princess Alexandra Hospital
EP29203
Poster Title: The Appropriateness of Clinical Referrals for CTPA Investigation at Princess Alexandra Hospital
Submitted on 18 Sep 2018
Author(s): Fatima Yusuf, Segilola Olakunbi, Mark Gregory, James K.Diss, Narmeen Taha, Sridhar Redla
Affiliations: None
This poster was presented at BIR
Poster Views: 691
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Poster Information
Abstract: Introduction: According to current guidelines, CTPA is the investigation of choice in patients with a high clinical suspicion of PE. Inappropriate CTPA use has a significant negative impact on patient safety, hospital resources and Radiology workload. Numerous published studies have shown that a validated pre-test diagnostic workup (including chest x-ray, Wells’ score and, if appropriate, D-dimer testing), is often not performed resulting in a low proportion of PE-positive scans. Here we assessed our local practice compared to RCR standards.

Materials & Methods: All CTPAs performed in two separate 2-week periods (March and May 2018) were retrospectively reviewed. Information including patient demographics, image request details and scan result was analysed.

Results: 18.2% (20/122) of examinations included in our study were PE-positive. An alternate diagnosis was reached in 52.2%. Only 24.1% cases provided details compliant with RCR guidelines on the imaging request, with non-compliance mainly due to the absence of a Wells’ score (81.2 %). Importantly, 26.1% cases with a Wells’ score greater than 4, and 32.1% with a D-dimer >1000 were positive for PE.

Conclusion: Current practice at PAH is in line with RCR standards regarding the proportion of PE-positive scans and alternate diagnoses reached, but imaging request criteria are not strictly followed, with the majority of cases not including a calculated Wells’ score and inappropriate D-dimer testing. Recommendations to improve this (hence reduce inappropriate CTPA referrals) are discussed.
Summary: The use of CT Pulmonary Angiography testing at PAH is in line with RCR standards regarding the proportion of PE-positive scans and alternate diagnoses reached, but imaging request criteria are not strictly followed. Work is ongoing to rectify this.References: .Report abuse »
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