A retrospective study of referral quality in suspected pulmonary embolism

Carol Ann Glorioso Rexen Busk*, Martin Weber Kusk, Søren Hess

*Corresponding author for this work

Research output: Contribution to conference without publisher/journalPosterResearchpeer-review

Abstract

Purpose or Learning Objective

Recent studies describe increasing use of CT angiography (CTA) and ventilation-perfusion scan (V/Q) in suspected pulmonary embolism (PE) with decreasing incidence, suggesting an inappropriate overutilization of imaging. Appropriateness of diagnostic imaging is critically evaluated based on clinical information in referrals and increased inappropriate use may be due to poor referral quality. Our aim was to retrospectively investigate local quality of referrals regarding Wells’ score and d-dimer information and incidence of PE.
Methods or Background

Patients with suspected PE referred for CTA and/or V/Q during a four-month period in 2019 at a 350-bed emergency service University hospital in Southwest Jutland were included. Clinical information was retrieved from referrals and patient medical charts; basic characteristics, scan conclusions, d-dimer, and Wells’ score. Not reported Wells' scores was calculated from available information in the medical chart.
Results or Findings

In total, 231 patients were included (106 CTA, 137 V/Q). PE incidence was 28.3% in CTA and 21.9% in V/Q. Wells’ score/d-dimer was reported in referrals for CTA in 5.7%/51.9% and for V/Q in 5.1%/50.4%.
In 38.1% CTA and 53.5% V/Q, Wells' score was low risk. Respectively, CTA and V/Q were positive for PE in 62.5% and 77.8% (high risk; score >6), 33.3% and 29.7% (intermediate risk; score 2-6), and 9.4% and 7.6% (low risk; score <2).
Conclusion

Wells’ score and d-dimer are important markers in PE but are only rarely included in referrals for CTA or V/Q in suspected PE. We found a clear correlation between Wells’ score and incidence, and our study suggests that including Wells’ score routinely in referrals might reduce the need for diagnostic imaging and thereby save resources and limit radiation exposure.
Limitations

Sample size, single-center, retrospective study
Ethics committee approval

Quality assurance study with no ethical approval required
Original languageEnglish
Publication dateJul 2022
Publication statusPublished - Jul 2022
EventEuropean Congress of Radiology - Supersonic Symposium, Vienna, Austria
Duration: 2. Mar 2016 → …

Conference

ConferenceEuropean Congress of Radiology
LocationSupersonic Symposium
Country/TerritoryAustria
CityVienna
Period02/03/2016 → …

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