Objectives: Guidelines and high-quality studies recommend using clinical decision-making (CDM) tools over clinical gestalt when evaluating a patient for pulmonary embolism. The purpose of this study is to investigate our computed tomography pulmonary angiogram (CTPA) utilization patterns and identify causal factors. Methods: A retrospective cohort study of CTPA studies ordered by emergency physicians in January, April, July, and October 2017 was undertaken. All necessary information to categorize patients by Wells' score, revised Geneva score, and pulmonary embolism rule-out criteria (PERC) was collected. In addition, various bloodwork, chest radiograph, and computed tomography results were collected. This data was analysed by the Pearson chi-square test or Fisher's exact test for categorical data and independent-samples t test for continuous variables. Results: A total of 510 CTPA studies were performed, with a mean age was 61.6 and a 50.6% female population. 136 studies (26.7%) failed to appropriately follow any CDM tool. CDM tool failure rate was dependent on whether the study was ordered from a community (14.9%) or tertiary hospital (University of Alberta Hospital, 27.9% and Royal Alexandra Hospital, 24.6%) (P = .038). Of these 136 studies, 31 were low/moderate risk and the d-dimer was negative. The remainder were either PERC-negative or low/moderate risk without d-dimer performed. The cumulative positive pulmonary embolism rate was 12.5%. With utilization of a CDM tool, the positive pulmonary embolism rate was 15.0%, compared to 5.9% when using gestalt (P = .026). Conclusions: This study confirms a high rate of CDM tool use failure, and a higher positive CTPA rate for CDM tools compared to clinical gestalt.
机构:
Childrens Hosp Philadelphia, Ctr Injury Res & Prevent, Philadelphia, PA 19104 USA
Childrens Hosp Philadelphia, Div Emergency Med, Philadelphia, PA 19104 USA
Univ Penn, Dept Pediat, Perelman Sch Med, Philadelphia, PA 19104 USAChildrens Hosp Philadelphia, Ctr Injury Res & Prevent, Philadelphia, PA 19104 USA
Zonfrillo, Mark R.
Kim, Konny H.
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Childrens Hosp Philadelphia, Ctr Injury Res & Prevent, Philadelphia, PA 19104 USAChildrens Hosp Philadelphia, Ctr Injury Res & Prevent, Philadelphia, PA 19104 USA
Kim, Konny H.
Arbogast, Kristy B.
论文数: 0引用数: 0
h-index: 0
机构:
Childrens Hosp Philadelphia, Ctr Injury Res & Prevent, Philadelphia, PA 19104 USA
Childrens Hosp Philadelphia, Div Emergency Med, Philadelphia, PA 19104 USA
Univ Penn, Dept Pediat, Perelman Sch Med, Philadelphia, PA 19104 USAChildrens Hosp Philadelphia, Ctr Injury Res & Prevent, Philadelphia, PA 19104 USA
机构:
Univ Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA
Univ Michigan, Ctr Healthcare Outcomes & Policy, Ann Arbor, MI 48109 USAUniv Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA
Kocher, Keith E.
Meurer, William J.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USAUniv Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA
Meurer, William J.
Fazel, Reza
论文数: 0引用数: 0
h-index: 0
机构:
Emory Univ, Div Cardiol, Dept Med, Atlanta, GA 30322 USAUniv Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA
Fazel, Reza
Scott, Phillip A.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USAUniv Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA
Scott, Phillip A.
Krumholz, Harlan M.
论文数: 0引用数: 0
h-index: 0
机构:
Yale Univ, Sch Med, Dept Med, Sect Cardiovasc Med, New Haven, CT 06510 USA
Sch Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT USA
Robert Wood Johnson Clin Scholars Program, Dept Med, New Haven, CT USAUniv Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA
Krumholz, Harlan M.
Nallamothu, Brahmajee K.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Michigan, Ctr Healthcare Outcomes & Policy, Ann Arbor, MI 48109 USA
VA Ann Arbor Hlth Serv Res & Dev Ctr Excellence, Ann Arbor, MI USA
Univ Michigan, Div Cardiovasc Med, Ann Arbor, MI 48109 USAUniv Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA
机构:
Johns Hopkins Univ, Sch Med, Russell H Morgan Dept Radiol & Radiol Sci, 600 N Wolfe St, Baltimore, MD 21287 USAJohns Hopkins Univ, Sch Med, Russell H Morgan Dept Radiol & Radiol Sci, 600 N Wolfe St, Baltimore, MD 21287 USA
Rowe, Steven P.
Rowe, Kristen H.
论文数: 0引用数: 0
h-index: 0
机构:
Johns Hopkins Bayview Med Ctr, Collaborat Inpatient Med Serv, Baltimore, MD USAJohns Hopkins Univ, Sch Med, Russell H Morgan Dept Radiol & Radiol Sci, 600 N Wolfe St, Baltimore, MD 21287 USA
Rowe, Kristen H.
Hill, Peter
论文数: 0引用数: 0
h-index: 0
机构:
Johns Hopkins Univ, Sch Med, Dept Emergency Med, Baltimore, MD USAJohns Hopkins Univ, Sch Med, Russell H Morgan Dept Radiol & Radiol Sci, 600 N Wolfe St, Baltimore, MD 21287 USA
Hill, Peter
Johnson, Pamela T.
论文数: 0引用数: 0
h-index: 0
机构:
Johns Hopkins Univ, Sch Med, Russell H Morgan Dept Radiol & Radiol Sci, 600 N Wolfe St, Baltimore, MD 21287 USAJohns Hopkins Univ, Sch Med, Russell H Morgan Dept Radiol & Radiol Sci, 600 N Wolfe St, Baltimore, MD 21287 USA
机构:
Univ Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USAUniv Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USA
Eskandari, Ali
Narayanasamy, Sabarish
论文数: 0引用数: 0
h-index: 0
机构:
Univ Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USAUniv Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USA
Narayanasamy, Sabarish
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Ward, Caitlin
Priya, Sarv
论文数: 0引用数: 0
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机构:
Univ Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USAUniv Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USA
Priya, Sarv
Aggarwal, Tanya
论文数: 0引用数: 0
h-index: 0
机构:
Univ Iowa, Dept Family Med, Carver Coll Med, Iowa City, IA 52242 USAUniv Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USA
Aggarwal, Tanya
Elam, Jacob
论文数: 0引用数: 0
h-index: 0
机构:
Univ Iowa, Carver Coll Med, Iowa City, IA 52242 USAUniv Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USA
Elam, Jacob
Nagpal, Prashant
论文数: 0引用数: 0
h-index: 0
机构:
Univ Wisconsin, Dept Radiol, Madison, WI 53706 USAUniv Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USA
机构:
Univ Tasmania, Tasmanian Sch Med, Coll Hlth & Med, Hobart, Tas 7000, AustraliaUniv Tasmania, Tasmanian Sch Med, Coll Hlth & Med, Hobart, Tas 7000, Australia
Thurlow, Lauren E.
Van Dam, Pieter J.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Tasmania, Sch Nursing, Coll Hlth & Med, Burnie, Tas 7320, AustraliaUniv Tasmania, Tasmanian Sch Med, Coll Hlth & Med, Hobart, Tas 7000, Australia
Van Dam, Pieter J.
Prior, Sarah J.
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h-index: 0
机构:
Univ Tasmania, Tasmanian Sch Med, Coll Hlth & Med, Burnie, Tas 7320, AustraliaUniv Tasmania, Tasmanian Sch Med, Coll Hlth & Med, Hobart, Tas 7000, Australia
Prior, Sarah J.
Tran, Viet
论文数: 0引用数: 0
h-index: 0
机构:
Univ Tasmania, Tasmanian Sch Med, Coll Hlth & Med, Hobart, Tas 7000, Australia
Royal Hobart Hosp, Emergency Dept, Hobart, Tas 7000, Australia
Univ Tasmania, Menzies Inst Med Res, Hobart, Tas 7000, AustraliaUniv Tasmania, Tasmanian Sch Med, Coll Hlth & Med, Hobart, Tas 7000, Australia
机构:
Childrens Hosp Philadelphia, Ctr Injury Res & Prevent, Philadelphia, PA 19104 USA
Childrens Hosp Philadelphia, Div Emergency Med, Philadelphia, PA 19104 USA
Univ Penn, Dept Pediat, Perelman Sch Med, Philadelphia, PA 19104 USAChildrens Hosp Philadelphia, Ctr Injury Res & Prevent, Philadelphia, PA 19104 USA
Zonfrillo, Mark R.
Kim, Konny H.
论文数: 0引用数: 0
h-index: 0
机构:
Childrens Hosp Philadelphia, Ctr Injury Res & Prevent, Philadelphia, PA 19104 USAChildrens Hosp Philadelphia, Ctr Injury Res & Prevent, Philadelphia, PA 19104 USA
Kim, Konny H.
Arbogast, Kristy B.
论文数: 0引用数: 0
h-index: 0
机构:
Childrens Hosp Philadelphia, Ctr Injury Res & Prevent, Philadelphia, PA 19104 USA
Childrens Hosp Philadelphia, Div Emergency Med, Philadelphia, PA 19104 USA
Univ Penn, Dept Pediat, Perelman Sch Med, Philadelphia, PA 19104 USAChildrens Hosp Philadelphia, Ctr Injury Res & Prevent, Philadelphia, PA 19104 USA
机构:
Univ Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA
Univ Michigan, Ctr Healthcare Outcomes & Policy, Ann Arbor, MI 48109 USAUniv Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA
Kocher, Keith E.
Meurer, William J.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USAUniv Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA
Meurer, William J.
Fazel, Reza
论文数: 0引用数: 0
h-index: 0
机构:
Emory Univ, Div Cardiol, Dept Med, Atlanta, GA 30322 USAUniv Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA
Fazel, Reza
Scott, Phillip A.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USAUniv Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA
Scott, Phillip A.
Krumholz, Harlan M.
论文数: 0引用数: 0
h-index: 0
机构:
Yale Univ, Sch Med, Dept Med, Sect Cardiovasc Med, New Haven, CT 06510 USA
Sch Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT USA
Robert Wood Johnson Clin Scholars Program, Dept Med, New Haven, CT USAUniv Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA
Krumholz, Harlan M.
Nallamothu, Brahmajee K.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Michigan, Ctr Healthcare Outcomes & Policy, Ann Arbor, MI 48109 USA
VA Ann Arbor Hlth Serv Res & Dev Ctr Excellence, Ann Arbor, MI USA
Univ Michigan, Div Cardiovasc Med, Ann Arbor, MI 48109 USAUniv Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA
机构:
Johns Hopkins Univ, Sch Med, Russell H Morgan Dept Radiol & Radiol Sci, 600 N Wolfe St, Baltimore, MD 21287 USAJohns Hopkins Univ, Sch Med, Russell H Morgan Dept Radiol & Radiol Sci, 600 N Wolfe St, Baltimore, MD 21287 USA
Rowe, Steven P.
Rowe, Kristen H.
论文数: 0引用数: 0
h-index: 0
机构:
Johns Hopkins Bayview Med Ctr, Collaborat Inpatient Med Serv, Baltimore, MD USAJohns Hopkins Univ, Sch Med, Russell H Morgan Dept Radiol & Radiol Sci, 600 N Wolfe St, Baltimore, MD 21287 USA
Rowe, Kristen H.
Hill, Peter
论文数: 0引用数: 0
h-index: 0
机构:
Johns Hopkins Univ, Sch Med, Dept Emergency Med, Baltimore, MD USAJohns Hopkins Univ, Sch Med, Russell H Morgan Dept Radiol & Radiol Sci, 600 N Wolfe St, Baltimore, MD 21287 USA
Hill, Peter
Johnson, Pamela T.
论文数: 0引用数: 0
h-index: 0
机构:
Johns Hopkins Univ, Sch Med, Russell H Morgan Dept Radiol & Radiol Sci, 600 N Wolfe St, Baltimore, MD 21287 USAJohns Hopkins Univ, Sch Med, Russell H Morgan Dept Radiol & Radiol Sci, 600 N Wolfe St, Baltimore, MD 21287 USA
机构:
Univ Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USAUniv Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USA
Eskandari, Ali
Narayanasamy, Sabarish
论文数: 0引用数: 0
h-index: 0
机构:
Univ Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USAUniv Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USA
Narayanasamy, Sabarish
论文数: 引用数:
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机构:
Ward, Caitlin
Priya, Sarv
论文数: 0引用数: 0
h-index: 0
机构:
Univ Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USAUniv Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USA
Priya, Sarv
Aggarwal, Tanya
论文数: 0引用数: 0
h-index: 0
机构:
Univ Iowa, Dept Family Med, Carver Coll Med, Iowa City, IA 52242 USAUniv Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USA
Aggarwal, Tanya
Elam, Jacob
论文数: 0引用数: 0
h-index: 0
机构:
Univ Iowa, Carver Coll Med, Iowa City, IA 52242 USAUniv Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USA
Elam, Jacob
Nagpal, Prashant
论文数: 0引用数: 0
h-index: 0
机构:
Univ Wisconsin, Dept Radiol, Madison, WI 53706 USAUniv Iowa, Dept Radiol, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USA
机构:
Univ Tasmania, Tasmanian Sch Med, Coll Hlth & Med, Hobart, Tas 7000, AustraliaUniv Tasmania, Tasmanian Sch Med, Coll Hlth & Med, Hobart, Tas 7000, Australia
Thurlow, Lauren E.
Van Dam, Pieter J.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Tasmania, Sch Nursing, Coll Hlth & Med, Burnie, Tas 7320, AustraliaUniv Tasmania, Tasmanian Sch Med, Coll Hlth & Med, Hobart, Tas 7000, Australia
Van Dam, Pieter J.
Prior, Sarah J.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Tasmania, Tasmanian Sch Med, Coll Hlth & Med, Burnie, Tas 7320, AustraliaUniv Tasmania, Tasmanian Sch Med, Coll Hlth & Med, Hobart, Tas 7000, Australia
Prior, Sarah J.
Tran, Viet
论文数: 0引用数: 0
h-index: 0
机构:
Univ Tasmania, Tasmanian Sch Med, Coll Hlth & Med, Hobart, Tas 7000, Australia
Royal Hobart Hosp, Emergency Dept, Hobart, Tas 7000, Australia
Univ Tasmania, Menzies Inst Med Res, Hobart, Tas 7000, AustraliaUniv Tasmania, Tasmanian Sch Med, Coll Hlth & Med, Hobart, Tas 7000, Australia