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RESPECT-ED: Rates of pulmonary emboli (PE) and sub-segmental PE with modern computed tomographic pulmonary angiograms in emergency departments: A multi-center observational study finds significant yield variation, uncorrelated with use or small PE rates
PLoS One
  • David Mountain, University of Western Australia
  • Gerben Keijzers, Bond University
  • Kevin Chu, University of Queensland
  • Anthony Joseph, Royal North Shore Hospital
  • Catherine Read, University of Western Australia
  • Gabriel Blecher, Monash University
  • Jeremy Furyk, Queensland Health Pathology Service
  • Chrianna Bharat, University of Western Australia
  • Karthik Velusamy, The Townsville Hospital
  • Andrew Munro, Nelson Hospital
  • Kylie Baker, Ipswich Hospital
  • Frances Kinnear, Prince Charles Hospital
  • Ahses Mukherjee, Armadale General Hospital
  • Gina Watkins, Sutherland Hospital
  • Paul Buntine, Box Hill Hospital
  • Georgia Livesay, Princess Alexandra Hospital Brisbane
  • Daniel Fatovich, University of Western Australia
Date of this Version
1-1-2016
Document Type
Journal Article
Publication Details

Published version

Mountain, D., Keijzers, G., Chu, K., Joseph, A., Read, C., Blecher, G., Furyk, J., Bharat, C., Velusamy, K., Munro, A., Baker, K., Kinnear, F., Mukherjee, A., Watkins, G., Buntine, P., Livesay, G., Fatovich, D. (2016). RESPECT-ED: Rates of pulmonary emboli (PE) and sub-segmental PE with modern computed tomographic pulmonary angiograms in emergency departments: A multi-center observational study finds significant yield variation, uncorrelated with use or small PE rates. PLoS One, 11(12) doi:10.1371/journal.pone.0166483

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Copyright © 2016 Mountain et al.

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Creative Commons Attribution 4.0
Abstract
INTRODUCTION: Overuse of CT Pulmonary Angiograms (CTPA) for diagnosing pulmonary embolism (PE), particularly in Emergency Departments (ED), is considered problematic. Marked variations in positive CTPA rates are reported, with American 4-10% yields driving most concerns. Higher resolution CTPA may increase sub-segmental PE (SSPE) diagnoses, which may be up to 40% false positive. Excessive use and false positives could increase harm vs. benefit. These issues have not been systematically examined outside America. AIMS: To describe current yield variation and CTPA utilisation in Australasian ED, exploring potential factors correlated with variation. METHODS: A retrospective multi-centre review of consecutive ED-ordered CTPA using standard radiology reports. ED CTPA report data were inputted onto preformatted data-sheets. The primary outcome was site level yield, analysed both intra-site and against a nominated 15.3% yield. Factors potentially associated with yield were assessed for correlation. RESULTS: Fourteen radiology departments (15 ED) provided 7077 CTPA data (94% ≥64-slice CT); PE were reported in 1028 (yield 14.6% (95%CI 13.8-15.4%; range 9.3-25.3%; site variation p DISCUSSION/ CONCLUSIONS: We found significant intra-site CTPA yield variation within Australasia. Yield was not clearly correlated with CTPA usage or increased small PE rates. Both SSPE and large PE rates were similar to higher yield historical cohorts. CTPA use was considerably below USA 2.5-3% rates. Higher CTPA utilisation was positively correlated with PE diagnoses, but without evidence of increased proportions of small PE. This suggests that increased diagnoses seem to be of clinically relevant sized PE.
Citation Information
David Mountain, Gerben Keijzers, Kevin Chu, Anthony Joseph, et al.. "RESPECT-ED: Rates of pulmonary emboli (PE) and sub-segmental PE with modern computed tomographic pulmonary angiograms in emergency departments: A multi-center observational study finds significant yield variation, uncorrelated with use or small PE rates" PLoS One Vol. 11 Iss. 12 (2016) p. 0166483 - 0166483 ISSN: 1932-6203
Available at: http://works.bepress.com/gerben_keijzers/33/