Annals of Thoracic Medicine
ORIGINAL ARTICLE
Year
: 2016  |  Volume : 11  |  Issue : 4  |  Page : 254--260

Suboptimal implementation of diagnostic algorithms and overuse of computed tomography-pulmonary angiography in patients with suspected pulmonary embolism


Sulaiman Alhassan1, Alaa Abu Sayf1, Camelia Arsene1, Hicham Krayem2 
1 Department of Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
2 Division of Pulmonary and Critical Care Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA

Correspondence Address:
Sulaiman Alhassan
717 Duncan Ave., Apt. No. 1008, Pittsburgh, PA 15237
USA

Background: Majority of our computed tomography-pulmonary angiography (CTPA) scans report negative findings. We hypothesized that suboptimal reliance on diagnostic algorithms contributes to apparent overuse of this test. Methods: A retrospective review was performed on 2031 CTPA cases in a large hospital system. Investigators retrospectively calculated pretest probability (PTP). Use of CTPA was considered as inappropriate when it was ordered for patients with low PTP without checking D-dimer (DD) or following negative DD. Results: Among the 2031 cases, pulmonary embolism (PE) was found in 7.4% (151 cases). About 1784 patients (88%) were considered “PE unlikely” based on Wells score. Out of those patients, 1084 cases (61%) did not have DD test prior to CTPA. In addition, 78 patients with negative DD underwent unnecessary CTPA; none of them had PE. Conclusions: The suboptimal implementation of PTP assessment tools can result in the overuse of CTPA, contributing to ineffective utilization of hospital resources, increased cost, and potential harm to patients.


How to cite this article:
Alhassan S, Sayf AA, Arsene C, Krayem H. Suboptimal implementation of diagnostic algorithms and overuse of computed tomography-pulmonary angiography in patients with suspected pulmonary embolism.Ann Thorac Med 2016;11:254-260


How to cite this URL:
Alhassan S, Sayf AA, Arsene C, Krayem H. Suboptimal implementation of diagnostic algorithms and overuse of computed tomography-pulmonary angiography in patients with suspected pulmonary embolism. Ann Thorac Med [serial online] 2016 [cited 2020 Sep 20 ];11:254-260
Available from: http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2016;volume=11;issue=4;spage=254;epage=260;aulast=Alhassan;type=0