|Pulmonary Embolism assessment why are we still getting it wrong!
|C. Donaghy, A Murray, T. Byrne, H. Kennedy, R. Kerr, L. McConville, G. McCurdy, A. Mclean, D. Rafferty, C. Sharkey, E Hayes
|Daisy Hill Hospital
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|General Respiratory and Sleep
|In haemodynamically stable patients a systematic approach to assessment should be undertaken to avoid unnecessary investigations. Whenever Pulmonary Embolism (PE) is suspected the pretest probability should be assessed. Meta-analyses suggest that probability scores may have higher specificity and increase the diagnostic yield of CTPA (1). Despite this they are used incorrectly in up to 80 percent of patients. (2)
We retrospectively audited patients who underwent CT pulmonary angiogram (CTPA) for a possible PE diagnosis in our hospital. Data was collected on each patients Wells score, D-dimer, bed days, Investigations and Pulmonary Embolism Severity Index Score (PESI.)
Results showed that PE detection percentage was in the range of 14% which is considered below the accepted standards set by clinical radiology. D-Dimers were performed inappropriately in 33% of patients. 70% of patients were found not to have had basic investigations completed. 55.5% of patients admitted to hospital had a PESI score of class 2 or less.
Patients continue to have incomplete assessments done prior to CTPA. Pre-test probability scoring has been shown to significantly improve detection rates of PE but continues to be underutilized in clinicians. Furthermore with the use of the PESI score a significant proportion of patients could be managed in the ambulatory setting.