RESPECT-ED: Rates of Pulmonary Emboli (PE) and Sub-Segmental PE with Modern Computed Tomographic Pulmonary Angiograms in Emergency Departments: A Multi-Center Observational Study Finds Significant Yield Variation, Uncorrelated with Use or Small PE Rates

• DOI: 10.1371/journal.pone.0166483
• Publication Date: 2016-12-05T13:23:04Z
• Authors: David Mountain; Gerben Keijzers; Kevin Chu; Anthony Joseph; Catherine Read; Gabriel Blecher; Jeremy Furyk; Chrianna Bharat; Karthik Velusamy; Andrew Munro; Kylie Baker; Frances Kinnear; Ahses Mukherjee; Gina Watkins; Paul Buntine; Georgia Livesay; Daniel Fatovich
• Keywords: Male; 1300 Biochemistry; Computed Tomography Angiography; Science; Genetics and Molecular Biology; Pulmonary Artery; 1100 Agricultural and Biological Sciences; 03 medical and health sciences; 0302 clinical medicine; Biomedical imaging; Humans; Rule; Retrospective Studies; Science & Technology; Australasia; Q; R; Angiography; General Medicine; Middle Aged; 3. Good health; Multidisciplinary Sciences; General Biochemistry; Emergency medicine; Science & Technology - Other Topics; Medicine; Female; CT Angiography; General Agricultural and Biological Sciences; Emergency Service, Hospital; Pulmonary Embolism; Tomography, X-Ray Computed; Research Article

Introduction Overuse of CT Pulmonary Angiograms (CTPA) for diagnosing pulmonary embolism (PE), particularly in Emergency Departments (ED), is considered problematic. Marked variations positive CTPA rates are reported, with American 4–10% yields driving most concerns. Higher resolution may increase sub-segmental PE (SSPE) diagnoses, which be up to 40% false positive. Excessive use and positives could harm vs. benefit. These issues have not been systematically examined outside America. Aims To describe current yield variation utilisation Australasian ED, exploring potential factors correlated variation. Methods A retrospective multi-centre review consecutive ED-ordered using standard radiology reports. ED report data were inputted onto preformatted data-sheets. The primary outcome was site level yield, analysed both intra-site against a nominated 15.3% yield. Factors potentially associated assessed correlation. Results Fourteen departments (15 ED) provided 7077 (94% ≥64-slice CT); reported 1028 (yield 14.6% (95%CI 13.8–15.4%; range 9.3–25.3%; p <0.0001) four sites significantly below one above the target. Admissions, usage, diagnosis size uncorrelated Large (≥lobar) 55% (CI: 52.1–58.2%) SSPE 8.8% 7.1–10.5%) scans. usage (0.2–1.5% adult attendances) (p<0.006) but SSPE: large proportions. Discussion/ Conclusions We found significant within Australasia. Yield clearly or increased small rates. Both similar higher historical cohorts. considerably USA 2.5–3% positively without evidence proportions PE. This suggests that diagnoses seem clinically relevant sized