Abstract:
Background: Computed tomographic pulmonary angiography (CTPA) is a gold standard test for the diagnosis of pulmonary embolism (PE), but is reported to be over prescribed. We performed this study to determine over prescription of CTPAs at a District General Hospital (DGH) in the United Kingdom. Our secondary aim was to establish a cause of its over-prescription. Methods: We retrospectively reviewed clinical data of all patients who underwent CTPAs during January 2011 to July 2013. Collected data included CTPA findings, clinical probability score, D-dimer results, chest x-ray (CXR) findings and patient's demographic data. A calculation of overall clinical probability (including initial and post CTPA values) and its cross analysis with D-dimer, CTPA and CXR findings was made. Results: Pulmonary embolism was positive in 5 (11.6%) cases. An Initial probability score was available in 16 (37.20%), and a D-dimer result was available in 33 (76.7%). Chest X-ray (CXR) was abnormal in 8 (18.6%). A coupling of total probability score with D-dimer results (CPPD) identified 10 (22.2%) potential over prescriptions. A further analysis of CPPD with CXR revealed a definite over prescription of 8 (18.6%), whereas it increased the number of an overall possible over prescription to 14 (32.6%). Conclusion: The CTPAs are being over prescribed and the main reasons behind it are poor utilization of probability scoring systems, D-dimer rule and lack of interpretation of alternative diagnosis on CXRs.
Page(s):
76-79
DOI:
DOI not available
Published:
Journal: Journal of Ayub Medical College, Volume: 26, Issue: 1, Year: 2014
Keywords:
xray computed
,
Pulmonary Embolism
,
Probability
,
Tomography
,
fibrin fragment D