Ordering CT pulmonary angiography to exclude pulmonary embolism: defense versus evidence in the emergency room.

Intensive Care Medicine
Martin RohacekChristoforos Stoupis

Abstract

To identify reasons for ordering computed tomography pulmonary angiography (CTPA), to identify the frequency of reasons for CTPA reflecting defensive behavior and evidence-based behavior, and to identify the impact of defensive medicine and of training about diagnosing pulmonary embolism (PE) on positive results of CTPA. Physicians in the emergency department of a tertiary care hospital completed a questionnaire before CTPA after being trained about diagnosing PE and completing questionnaires. Nine hundred patients received a CTPA during 3 years. For 328 CTPAs performed during the 1-year study period, 140 (43 %) questionnaires were completed. The most frequent reasons for ordering a CTPA were to confirm/rule out PE (93 %), elevated D-dimers (66 %), fear of missing PE (55 %), and Wells/simplified revised Geneva score (53 %). A positive answer for "fear of missing PE" was inversely associated with positive CTPA (OR 0.36, 95 % CI 0.14-0.92, p = 0.033), and "Wells/simplified revised Geneva score" was associated with positive CTPA (OR 3.28, 95 % CI 1.24-8.68, p = 0.017). The proportion of positive CTPA was higher if a questionnaire was completed, compared to the 2-year comparison period (26.4 vs. 14.5 %, OR 2.12, 95 % CI 1.36-3.29, ...Continue Reading

References

Nov 22, 1997·Journal of Clinical Epidemiology·D A AschN A Christakis
Jun 2, 2005·JAMA : the Journal of the American Medical Association·David M StuddertTroyen A Brennan
Nov 26, 2005·Annals of Emergency Medicine·David A KatzHarry P Selker
Jul 1, 2006·Journal of General Internal Medicine·Frederick A SpencerRobert J Goldberg
Dec 13, 2006·Journal of Thrombosis and Haemostasis : JTH·M Di NisioP M M Bossuyt
Oct 24, 2008·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Debra EaglesJeffrey J Perry
Oct 29, 2008·Archives of Internal Medicine·Frederikus A KlokMenno V Huisman
Feb 10, 2010·Journal of General Internal Medicine·Laura D Hermer, Howard Brody
Apr 7, 2010·Journal of Evaluation in Clinical Practice·Markus U BoehnertAristomenis K Exadaktylos
Jul 2, 2010·The New England Journal of Medicine·Giancarlo Agnelli, Cecilia Becattini
Sep 8, 2010·Health Affairs·Michelle M MelloDavid M Studdert
Aug 19, 2011·The New England Journal of Medicine·Anupam B JenaAmitabh Chandra
Oct 4, 2011·Intensive Care Medicine·Robinder G KhemaniUNKNOWN NICHD Collaborative Pediatric Critical Care Research Network (CPCCRN)
Dec 20, 2011·Annals of Emergency Medicine·Balwinder SinghSubhash Chandra
Jan 20, 2012·Journal of Community Health·Monte Malach, William J Baumol

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Citations

Jun 12, 2013·European Journal of Nuclear Medicine and Molecular Imaging·Carl Schuemichen
Oct 24, 2012·PloS One·Martin RohacekAristomenis Exadaktylos
Feb 25, 2014·The American Journal of Emergency Medicine·Marc A ProbstDavid L Schriger
Sep 4, 2013·The American Journal of Emergency Medicine·Matthew B LevineDamon R Kuehl
Dec 12, 2012·Anaesthesia·K Somasundaram, J Ball
Aug 31, 2014·The American Journal of Emergency Medicine·Fu-Jen ChengKuan-Han Wu
Dec 25, 2016·Intensive Care Medicine·Carmen A PfortmuellerAristomenis K Exadaktylos
Jul 5, 2017·CJEM·Amjed Kadhim-SalehJeffrey J Perry
Jun 27, 2017·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Lauren K ToneySwetha R Palli
Aug 16, 2019·BMC Medical Imaging·Chiao-Hsuan ChienChee-Wai Mak
Mar 28, 2017·Health and Quality of Life Outcomes·Silvia C RichnerDelphine S Courvoisier
May 7, 2021·The American Journal of Emergency Medicine·Tzu-Yun LiuChi-Yung Cheng
Sep 29, 2015·Annals of Internal Medicine·Ali S RajaUNKNOWN Clinical Guidelines Committee of the American College of Physicians

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