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Abstract: Slide Presentations |

IMPROVING COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAM (CTPA) UTILIZATION IN SUSPECTED PULMONARY EMBOLISM FREE TO VIEW

Guy W. Soo Hoo, MD*; Carol C. Wu, MD; Sondra Vazirani, MD; Zhaoping Li, MD; Bruce M. Barack, MD
Author and Funding Information

West Los Angeles VA Healthcare Center, Los Angeles, CA


Chest


Chest. 2009;136(4_MeetingAbstracts):13S-j-14S. doi:10.1378/chest.136.4_MeetingAbstracts.13S-j
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Published online

Abstract

PURPOSE:  Computed Tomographic Pulmonary Angiography (CTPA) has become the procedure of choice in evaluating patients with suspected pulmonary embolism (PE). The Wells score as a clinical decision rule (CDR), combined with a highly sensitive D-dimer has been useful in a mostly outpatient population. Experience in hospitalized patients is limited. The purpose of this study was to describe the experience with this approach in mostly hospitalized patients with suspected PE.

METHODS:  Guidelines using a CDR and highly sensitive D-dimer were incorporated into a computerized order entry menu. All requests for CTPA required results of a CDR and D-dimer if indicated before proceeding to CTPA. After guideline implementation, all CTPAs per formed from December 2006 to November 2008 at our institution were reviewed.

RESULTS:  A total of 261 CTPAs were performed with 43 (16.5%) positive for PE, compared to a previous 5% yield. The CDR score and D-dimer were 5.5 ± 2.4 and 4965 ± 2892 ng/ml respectively for those with PE compared to 4.5 ± 2.1 and 2398 ± 2100 ng/ml (both p < 0.01) without PE. The negative predictive value of a CDR score < 4 and D-dimer <500 and <1000 ng/ml was 1.0. A logistic regression model that combined a CDR score > 4 and D-dimer > 3000 ng/ml was the best at identifying patients with PE (72%). A CDR > 4 and increasing D-dimer levels were associated with increasing percent of PE as outlined in the table.

CONCLUSION:  Guidelines combining a CDR with D-dimer can increase the yield of CTPA in hospitalized patients. This increased yield will reduce the number of negative CTPAs performed. A CDR score < 4 and D-dimer <1000 ng/ml may be useful in identifying patients who require no further evaluation for PE. A CDR > 4 and elevated D-dimer > 3000 ng/ml may identify patients more likely to have a PE.

CLINICAL IMPLICATIONS:  A CDR and highly sensitive D-dimer may be useful in identifying hospitalized patients with high and low likelihood for PE.

DISCLOSURE:  Guy Soo Hoo, No Financial Disclosure Information; No Product/Research Disclosure Information

Monday, November 2, 2009

10:30 AM - 12:00 PM


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