Mandatory adherence to diagnostic protocol increases the yield of CTPA for pulmonary embolism

• Published in: Insights into imaging Vol. 7; no. 5; pp. 727 - 734
• Main Authors: Walen, Stefan, de Boer, Erwin, Edens, Mireille A., van der Worp, Corné A. J., Boomsma, Martijn F., van den Berg, Jan Willem K.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2016; Springer Nature B.V; SpringerOpen
• Subjects: CTPA (computed tomography pulmonary angiography); Diagnostic protocol; Diagnostic Radiology; Diagnostic yield; Imaging; Internal Medicine; Interventional Radiology; Medicine; Medicine & Public Health; Neuroradiology; Original; Original Article; Protocol adherence; Pulmonary embolism; Radiology; Ultrasound; Pulmonary embolism; Diagnostic yield; CTPA (computed tomography pulmonary angiography); Protocol adherence; Diagnostic protocol
• ISSN: 1869-4101; 1869-4101
• DOI: 10.1007/s13244-016-0509-2

Objectives To determine if mandatory adherence to a diagnostic protocol increases the rate of computed tomography pulmonary angiographies (CTPAs) positive for pulmonary embolism (PE)—the so-called diagnostic yield. Further, we aim to identify factors associated with this diagnostic yield. Methods We included all patients with suspected PE requiring CTPA from 9 January 2014 t0 3 June 2014. The requesting physicians were forced to follow diagnostic workup for PE by calculating a Wells score and, if necessary, determining D-dimer level. The percentage of positive CTPA scans was calculated and compared with our previous cohort (Walen et al. Insights Imaging 2014;5(2):231–236). Odds ratios were calculated as a measure of association between dichotomous variables and CTPA findings. Results Of 250 scans, 74 were positive (29.6 % [95 % CI, 24.3-35.5 %]) and 175 were negative (70 %). The percentage positive scans increased with 6.6 % and the percentage negative scans decreased with 3.1 %. This change was statistically significant ( p  = 0.001). Independent clinical predictors of diagnostic yield were previous deep venous thrombosis (DVT) (OR, 3.22; p  = 0.013) and clinical signs of DVT (OR, 2.71; p  = 0.012). Chronic obstructive pulmonary disease (COPD) was negatively associated with PE (OR, 0.33; p  = 0.045). Conclusions This study shows that mandatory adherence to a diagnostic protocol increases the yield of CTPA for PE in our centre. Main Messages • Mandatory adherence to diagnostic protocol increases the yield of CTPA for PE • Previous DVT and signs of DVT were associated with a higher yield • No patients with a low Wells score and a low D-dimer had PE