Appropriateness of CT pulmonary angiograms according to current diagnostic guidelines based on risk stratification: A retrospective single-center study
Language English Country Czech Republic Media print-electronic
Document type Journal Article, Validation Study
PubMed
33087940
DOI
10.5507/bp.2020.049
Knihovny.cz E-resources
- Keywords
- CT examination justification, CT pulmonary angiography, D-Dimers, acute pulmonary embolism, clinical decision making, diagnostic guidelines,
- MeSH
- Computed Tomography Angiography * MeSH
- Fibrin Fibrinogen Degradation Products analysis MeSH
- Risk Assessment MeSH
- Middle Aged MeSH
- Humans MeSH
- Pulmonary Embolism blood diagnostic imaging MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Practice Guidelines as Topic MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Validation Study MeSH
- Names of Substances
- fibrin fragment D MeSH Browser
- Fibrin Fibrinogen Degradation Products MeSH
BACKGROUND AND AIM: Assessment of appropriateness of CT pulmonary angiograms (CTPA) in patients with suspected pulmonary embolism (PE) is based on risk stratification algorithms such as simplified the Geneva Score (sGS) in combination with D-dimer blood tests. The aim of this study was to validate the diagnostic yield and appropriateness of CTPA examinations in accordance with 2014 European Society of Cardiology (ESC) guidelines. MATERIALS AND METHODS: Data from 155 outpatients who underwent CTPA for clinical suspicion of PE were gathered from the radiology information system (RIS) and the clinical information system (CIS). We assessed the presence of sGS items and D-dimer blood test results in RIS from CTPA request forms and from clinical documentation in CIS. RESULTS: Based on the RIS, there were 2.6% patients with high (sGS≥3) and 97.4% patients with low pre-test PE probability (sGS<3), and CTPA indication was formally comprehendible in 75.5% using sGS and D-dimer blood tests. Based on RIS and CIS data in combination, there were 41.3% patients with high and 58.7% patients with low pre-test PE probability, and CTPA indication was formally comprehendible in 88.4%. Using RIS and CIS in combination, PE probability was upgraded from low to high probability in 39.7% compared with RIS alone. In 12.9%, there was a lack of data in RIS for CTPA justification. CONCLUSION: There is a high diagnostic yield when applying current diagnostic guidelines to our data. There was however a notable discrepancy between the data transferred to the CTPA request forms from the full clinical documentation, therefore not readily available for clinical decision making.
2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Cardiology University Hospital Heidelberg Heidelberg Germany
Department of Diagnostic and Interventional Radiology University Hospital Heidelberg Germany
Department of Endocrinology University Hospital Heidelberg Heidelberg Germany
Institute of Anatomy 2nd Faculty of Medicine Charles University Prague Czech Republic
Translational Lung Research Center Heidelberg University of Heidelberg Heidelberg Germany
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