Pulmonary Vascular Disease |

Prospective Validation of the Diagnostic Algorithm in the Evaluation of Patients With Suspected Pulmonary Embolism FREE TO VIEW

Anand Rose, MBBS; Neil Jones; Richard Woodman
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Flinders Medical Centre, Mitchell Park, SA, Australia

Chest. 2014;146(4_MeetingAbstracts):824A. doi:10.1378/chest.1992835
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Pulmonary Embolism (PE) is a condition frequently considered in clinical practice. Clinical risk stratification is the first step in the diagnostic algorithm. This is followed by use of the D'Dimer and confirmatory imaging in the appropriate patient. There is little prospective data on the algorithm's impact on yield of confirmatory imaging, and resource utilisation.

METHODS: An electronic risk calculator was constructed (to compute the Wells and the revised Geneva risk scores) and a diagnostic algorithm was implemented in a tertiary teaching hospital in South Australia. Clinicians were mandated to use the above when a diagnosis of PE was suspected. The performance of the Wells and Revised Geneva risk scores was compared prospectively over a 3 month period. The yield from confirmatory imaging before and after the intervention was analysed. The number of confirmatory radiological tests - CTPA (Computed Tomography Pulmonary Angiogram) & Nuclear Medicine (NM) Ventilation Perfusion Scans - were examined before and after the implementation of the diagnostic algorithm.

RESULTS: In this prospective comparison there was no statistically significant difference in the performance of the Wells score and the Revised Geneva score. The positive yield from confirmatory imaging increased from 10 - 19%. There was a statistically significant decline in the number of scans following implementation of the algorithm when compared to a historical cohort 2 years prior to implementation (p=0.03).

CONCLUSIONS: 1. The diagnostic algorithm incorporating clinical risk stratification (in all patients), D'Dimer and confirmatory imaging (in the appropriate patient) is safe and effective. 2. There is an increase in yield from confirmatory imaging following implementation of the diagnostic algorithm. 3. There is a statistically significant reduction (20%) in resource utilisation of confirmatory imaging (CTPA & NM ventilation perfusion scans) when compared to a historical cohort 2 years prior to imaging.

CLINICAL IMPLICATIONS: Clinicians should be encouraged to use the risk stratification tools and the diagnostic algorithm in clinical practice. When clinicians adhere to the algorithm, the yield of confirmatory imaging increases to 19% in our cohort. Further work in examining and modifying the existing diagnostic algorithm is important.This could refine the sample being tested and reduce unnecessary radiological investigations.

DISCLOSURE: The following authors have nothing to disclose: Anand Rose, Neil Jones, Richard Woodman

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