Mandatory adherence to diagnostic protocol increases the yield of CTPA for pulmonary embolism.
Insights Imaging
; 7(5): 727-34, 2016 Oct.
Article
em En
| MEDLINE
| ID: mdl-27448688
ABSTRACT
OBJECTIVES:
To determine if mandatory adherence to a diagnostic protocol increases the rate of computed tomography pulmonary angiographies (CTPAs) positive for pulmonary embolism (PE)-the so-called diagnostic yield. Further, we aim to identify factors associated with this diagnostic yield.METHODS:
We included all patients with suspected PE requiring CTPA from 9 January 2014 t0 3 June 2014. The requesting physicians were forced to follow diagnostic workup for PE by calculating a Wells score and, if necessary, determining D-dimer level. The percentage of positive CTPA scans was calculated and compared with our previous cohort (Walen et al. Insights Imaging 2014;5(2)231-236). Odds ratios were calculated as a measure of association between dichotomous variables and CTPA findings.RESULTS:
Of 250 scans, 74 were positive (29.6 % [95 % CI, 24.3-35.5 %]) and 175 were negative (70 %). The percentage positive scans increased with 6.6 % and the percentage negative scans decreased with 3.1 %. This change was statistically significant (p = 0.001). Independent clinical predictors of diagnostic yield were previous deep venous thrombosis (DVT) (OR, 3.22; p = 0.013) and clinical signs of DVT (OR, 2.71; p = 0.012). Chronic obstructive pulmonary disease (COPD) was negatively associated with PE (OR, 0.33; p = 0.045).CONCLUSIONS:
This study shows that mandatory adherence to a diagnostic protocol increases the yield of CTPA for PE in our centre. MAIN MESSAGES ⢠Mandatory adherence to diagnostic protocol increases the yield of CTPA for PE ⢠Previous DVT and signs of DVT were associated with a higher yield ⢠No patients with a low Wells score and a low D-dimer had PE.
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Base de dados:
MEDLINE
Tipo de estudo:
Diagnostic_studies
/
Guideline
/
Prognostic_studies
Idioma:
En
Ano de publicação:
2016
Tipo de documento:
Article