NDLI: The use of clinical decision rules for pulmonary embolism in the emergency department: a retrospective study

Content Provider	Springer Nature : BioMed Central
Author	Al Dandan, Omran Hassan, Ali Alnasr, Afnan Al Gadeeb, Mohammed AbuAlola, Hossain Alshahwan, Sarah Al Shammari, Malak Alzaki, Alaa
Abstract	Background Pulmonary embolism (PE) is a common and life-threatening medical condition with non-specific clinical presentation. Computed tomography pulmonary angiography (CT-PA) has been the diagnostic modality of choice, but its use is not without risks. Clinical decision rules have been established for the use of diagnostic modalities for patients with suspected PE. This study aims to assess the adherence of physicians to the diagnostic algorithms and rules. Methods A retrospective observational study examining the utilization of CT-PA in the Emergency Department of King Fahd Hospital of Imam Abdulrahman Bin Faisal University for patients with suspected PE from May 2016 to December 2019. The electronic health records were used to collect the data, including background demographic data, clinical presentation, triage vital signs, D-dimer level (if ordered), risk factors for PE, and the CT-PA findings. The Wells score and pulmonary embolism rule-out (PERC) criteria were calculated retrospectively without knowledge of the results of D-dimer and the CT-PA. Results The study involved a total of 353 patients (125 men and 228 women) with a mean age of 46.7 ± 18.4 years. Overall, 200 patients (56.7%) were classified into the “PE unlikely” group and 153 patients (43.3%) in the “PE likely” group as per Wells criteria. Out of all the CT-PA, 119 CT-PA (33.7%) were requested without D-dimer assay (n = 114) or with normal D-dimer level (n = 5) despite being in the “PE unlikely” group. Only 49 patients had negative PERC criteria, of which three patients had PE. Conclusions The study revealed that approximately one-third of all CT-PA requests were not adhering to the clinical decision rules with a significant underutilization of D-dimer assay in such patients. To reduce overutilization of imaging, planned interventions to promote the adherence to the current guidelines seem imperative.
Related Links	https://intjem.biomedcentral.com/counter/pdf/10.1186/s12245-020-00281-1.pdf
Ending Page	6
Page Count	6
Starting Page	1
File Format	HTM / HTML
ISSN	18651380
DOI	10.1186/s12245-020-00281-1
Journal	International Journal of Emergency Medicine
Issue Number	1
Volume Number	13
Language	English
Publisher	BioMed Central
Publisher Date	2020-05-11
Access Restriction	Open
Subject Keyword	Emergency Medicine Internal Medicine Cardiology Angiology Pediatrics Computed Tomography Pulmonary embolism Wells criteria Guidelines
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
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