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- Title
Overuse of Computed Tomography Pulmonary Angiography and Low Utilization of Clinical Prediction Rules in Suspected Pulmonary Embolism Patients at a Regional Australian Hospital.
- Authors
Chean, Li Ning; Tan, Clement; Hiskens, Matthew I.; Rattenbury, Marie; Sundaram, Prahalath; Perara, Jithmy; Smith, Karen; Kumar, Pranav
- Abstract
A pulmonary embolism (PE) is an obstruction in the pulmonary arterial system and may include non-specific signs and symptoms. Clinical prediction rules (CPRs) assess the pretest probability (PTP) of a PE to prevent the overuse of computed tomography pulmonary angiography (CTPA). CTPA overuse results in patient harm and health system waste. This study aimed to evaluate CTPA usage in an Australian regional hospital through analyzing CTPA encounters. A retrospective chart analysis was undertaken of 100 CTPAs conducted at an Australian regional hospital from April to May 2023. Analysis was undertaken for parameters including risk factors, signs and symptoms, investigations, and the use of CPRs. Overall, 86% of patients had signs and/or symptoms of a PE within a week of examination, and 6% of the population had signs of deep vein thrombosis. More than half of the population had no risk factors, while the most prevalent risk factors were a recent history of immobilization/trauma and/or having surgery that required general anesthesia in the last 4 weeks. The most common co-morbidity was chronic lung disease (11%). For the pre-test diagnostic workup, the ECG was the most ordered investigation. The Wells' score was used at 10%, while most patients did not have any CPRs applied. The prevalence of PEs discovered on CTPAs was 9%. CPRs were under-utilized in this Australian regional hospital. The D-dimers for ruling out subjects with low PTP derived from CPRs were also underused. This led to the inappropriate overordering of CTPAs, resulting in negative implications for patients and unnecessary costs to the health system.
- Subjects
AUSTRALIA; INJURY complications; LUNG radiography; BLOOD vessels; PULMONARY embolism; GENERAL anesthesia; LUNG diseases; CHRONIC diseases; UNNECESSARY surgery; CLINICAL prediction rules; RETROSPECTIVE studies; SURGICAL complications; ACQUISITION of data; RISK assessment; MEDICAL care use; VENOUS thrombosis; THERAPEUTIC immobilization; PUBLIC hospitals; DESCRIPTIVE statistics; ELECTROCARDIOGRAPHY; MEDICAL records; CHI-squared test; COMPUTED tomography; DATA analysis software; COMORBIDITY; DISEASE risk factors; SYMPTOMS
- Publication
Healthcare (2227-9032), 2024, Vol 12, Issue 2, p278
- ISSN
2227-9032
- Publication type
Article
- DOI
10.3390/healthcare12020278