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Pulmonary Vascular Disease |

Analysis of Use of CT Angiogram in "Rule Out Pulmonary Embolism" Patients: Can We Increase Effectiveness?

Pavan Gorukanti*, MD; Venu Gourineni, MD; Sarah Hession, PhD; Priyank Patel, MD; Suprathik Rayamajhi, MD; Saniya Khan, MD; Larry Rawsthorne, MD
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Dept of Internal Medicine, Michigan State University, Lansing, MI


Chest. 2012;142(4_MeetingAbstracts):842A. doi:10.1378/chest.1389259
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Abstract

SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: We sought to assess the appropriateness of use of computed tomography angiogram (CTA) for screening for pulmonary embolism (PE). We also evaluated if use of PERC rule and increasing the threshold for positivity of D-dimer levels can decrease the need for excessive CTAs.

METHODS: We retrospectively reviewed charts of adult patients presenting to the Emergency Department from July to December 2010 who had a CTA to rule out PE. We assessed demographics; revised Geneva score; PERC rule and D-dimer levels (further stratified into negative <0.5 mcg/ml; low positive 0.5-0.99 mcg/ml; high positive >1.0 mcg/ml) for all patients. Preliminary analysis of the first 505 patients is being presented.

RESULTS: Of 505 patients only 21 patients had a PE by CTA. Commonest complaints prompting a CTA were chest pain(55 %) and dyspnea(55.25 %). Of the patients who had PE, 61.9% did not present with chest pain. PE was seen in 2 of 19 patients who presented with syncope and 2 of 8 patients with hemoptysis. D-dimer was available in 270(53.5%) patients and 9, 22 and 231 patients were in the negative, low level positive and high positive subgroups respectively. None of the 13.5% of total patients who met PERC rule had PE. D-dimer was available in 221 patients who did not meet PERC rule and all 7 of them who had PE had high positive D-dimer(>1). As per revised Geneva scoring, 2 out of 181 patients with low probability, 16 out of 287 with intermediate probability and 3 of 37 with high probability had PE. All the PE patients who had an available D-dimer, had a value >1.

CONCLUSIONS: Overall yield of CT scans in ‘ruling out PE’ was low(4.15%). Our study indicates that PERC rule is effective in ruling out PE. In patients with low and intermediate probability of revised GENEVA score, increasing the D-dimer threshold may be acceptable.

CLINICAL IMPLICATIONS: Our study shows that use of available well validated tools and changing laboratory cutoffs may decrease inappropriate workup.

DISCLOSURE: The following authors have nothing to disclose: Pavan Gorukanti, Venu Gourineni, Sarah Hession, Priyank Patel, Suprathik Rayamajhi, Saniya Khan, Larry Rawsthorne

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Dept of Internal Medicine, Michigan State University, Lansing, MI

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