Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
Search Ahead of print Current Issue Archives Instructions Subscribe e-Alerts Login 
Home Email this article link Print this article Bookmark this page Decrease font size Default font size Increase font size
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

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
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1817-1737.191875

Rights and Permissions

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.

Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded498    
    Comments [Add]    
    Cited by others 18    

Recommend this journal