Implementation of a clinical prediction tool for pulmonary embolism diagnosis in a tertiary teaching hospital reduces the number of computed tomography pulmonary angiograms performed

Chongweng Ong, Vivek Malipatil, M Lavercombe, K G W Teo, Paul Bernard Coughlin, Deborah S Leach, Manfred Spanger, Francis Thien

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Abstract

To evaluate the effect of implementing the Wells score clinical prediction tool (CPT) on rationalising the use of computed tomography pulmonary angiography (CTPA) for diagnosing pulmonary embolism (PE). Methods: Within a tertiary teaching hospital, a retrospective study was conducted applying Wells score to all CTPA ordered in the first quarter of 2007. Subsequently, an algorithm including Wells score and d-dimer assay was developed to assist clinicians in rationalising their ordering of CTPA. A prospective study was performed from February to August 2009 to assess the impact of this algorithm. CTPA results, d-dimer levels, referral sources and dates were recorded. The number of CTPA performed over a 7-month period following implementation of the algorithm was compared with the same period during the previous year. PE prevalence within each risk category was compared with the published literature. Results: Three hundred and thirty-three patients were investigated with CTPA in the prospective study period. Two hundred and sixty-eight patients (80.4 of cases) had complete data. The prevalence of PE in the present study was 13.8 with 57 (21.2 ) patients stratified to low risk, 169 (63.0 ) to intermediate risk and 42 (15.6 ) to high risk. Subgroup prevalence was 8.8 , 11.8 and 23.8 respectively. Compared with the same period in 2008, 121 (26.6 ) less CTPA were performed. Conclusion: Institutional implementation of a clinical prediction tool into the decision-making process is feasible and significantly reduces the number of CTPA being performed, with substantial cost savings and patient benefits. ? 2012 The Authors. Internal Medicine Journal ? 2012 Royal Australasian College of Physicians
Original languageEnglish
Pages (from-to)169 - 174
Number of pages6
JournalInternal Medicine Journal
Volume43
Issue number2
DOIs
Publication statusPublished - 2013

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