Pulmonary Vascular Disease |

Computed Tomography of the Chest: Indications and Utilization in the Community Hospital Emergency Department FREE TO VIEW

Thomas Willson, MD; Benjamin Larsen, MD; Matthew Blecha, MD; Mark Connolly, MD; Francis Podbielski, MD
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Saint Joseph Hospital, Chicago, IL

Chest. 2014;145(3_MeetingAbstracts):533A. doi:10.1378/chest.1836673
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SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Chest computed tomography (CT) has replaced angiography and ventilation/perfusion scanning as the diagnostic method of choice for pulmonary embolism. This study reviews the indications and outcomes of chest CT scanning in the setting of a non-trauma based community hospital Emergency Department (ED) in an effort to develop a “best practice” guideline that optimizes patient care while minimizing radiation exposure and cost.

METHODS: This is a retrospective, observational study that reviews all (n=388) chest CT scans performed in the ED at our institution (Presence - St. Joseph Hospital - Chicago, IL) over a one-year period (5/1/2012 - 4/30/2013). Patient demographics, medical history, imaging and laboratory results, hospital course, and diagnosis were abstracted from the available medical records.

RESULTS: The most common indications for ED chest CT scans were: pulmonary embolism (80%), aortic pathology (8%), and trauma (4%). Chest CT yield for either emergency findings or thoracic findings requiring follow-up was 37%. When no substantial findings beyond those seen on a chest radiograph were eliminated, the yield of CT scanning was 20%. Thirty-six percent of CT scans had no significant findings, while studies with clinically insignificant or non-thoracic findings made up the remainder. Studies for clinically suspected pulmonary embolism had a 9% yield while studies for aortic pathology had a 3% yield. New pulmonary nodules were detected in 5% of patients. Of those patients, under 30% had follow up imaging or biopsy.

CONCLUSIONS: Given the ubiquity of CT scanning in the United States, the indications are widely varied. This creates the potential for patients with any type of underlying respiratory illness to be at risk for overexposure to diagnostic radiation given their propensity to be evaluated in hospital EDs with shortness of breath or chest pain for a variety of reasons, which rarely include clinically significant pulmonary emboli. The unintended consequence of this over-use of CT scanning also creates a need for regimented follow-up of incidentally discovered pulmonary nodules and other findings. We would recommend that EDs institute a procedure to ensure follow up for patients with such incidental, non-emergency findings.

CLINICAL IMPLICATIONS: Patients undergoing chest CT in the emergency setting seem to be at risk for inadequate follow-up of incidental findings, suggesting a need for more robust ED to primary care communication systems.

DISCLOSURE: The following authors have nothing to disclose: Thomas Willson, Benjamin Larsen, Matthew Blecha, Mark Connolly, Francis Podbielski

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