MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Pulmonary disorders
W093
PULMONARY EMBOLISM POSITIVE POINT PREVALENCE IN 32 CLINICAL STUDIES THAT UTILIZE CHEST CTA IN THE DETECTION OF PULMONARY EMBOLISM IN AT RISK PATIENTS
E. Sloan 1, C. Sloan 2, T. Dunne 3
1
University Of Illinois College Of Medicine, Chicago, Usa, 2 Tufts University College Of Medicine, Boston, Usa, Rush University College Of Medicine, Chicago, Usa
3
Background: The pulmonary embolism (PE) point prevalence in patients considered to be at risk for PE may be sufficiently low to allow for a safe reduction in chest CT Angiography (CTA) use. A benchmark remains unidentified for the rate at which chest CTA should be positive for PE in clinical practice, especially in the Emergency Department (ED). The objective of this study was to determine the PE point prevalence rates in studies that utilize CTA in the diagnostic process, including both studies that established CTA test characteristics and clinical studies that used CTA to diagnose PE. Methods: Included in the analysis were studies that identified the use of CTA in the diagnosis of PE in at risk patients and overall populations, and patients with clinical criteria that suggested high risk for PE. Results: Of 164 possible PE studies examined, 32 (20%) specifically reported the outcomes of CTA use for the diagnosis of PE among 26,989 at risk patients. The overall PE point prevalence positive rate in these 32 CTA use studies was 17.6 + 14.9%. ED studies with CTA use reported a lower CTA positive rate (10.1%) than studies from other clinical settings (27.1%) (p<.05). Studies that examined PE point prevalence in at risk patients had a lower CTA positive rate than those studies that primarily established CTA test characteristics (15.0 vs. 21.7%). Conclusions: The overall 17.6% point prevalence rates for PE in studies that examined CTA utilization were similar to the 18% PE positive point prevalence rate observed in all 164 PE patient diagnostic studies reviewed. In the ED, CTA testing was positive in 10% of patients. This low CTA positive rate suggests that CTA may be over-utilized, especially if this test is not preceded by D-dimer testing in patients without clinical criteria that strongly suggest high PE risk. This 10% ED patient positive CTA rate for PE can serve as a benchmark for comparison as emergency physicians strive to improve quality and patient safety through optimizing the use of CTA in at risk ED patients.