A Computerized Method for Measuring Computed Tomography Pulmonary Angiography Yield in the Emergency Department:...

Area of Science:

• Radiology
• Health Informatics
• Medical Imaging Analysis

Background:

• Computed tomography pulmonary angiography (CTPA) use for pulmonary embolism (PE) diagnosis has increased, but carries risks like contrast-induced nephropathy and malignancy.
• Monitoring CTPA yield (percentage of positive tests) is crucial for assessing appropriate use and mitigating iatrogenic harm.
• This study introduces and validates a novel computerized method for calculating CTPA yield in the emergency department (ED).

Purpose of the Study:

• To assess the validity of a novel computerized method for calculating CTPA yield in the ED.
• To establish an efficient and accurate approach for monitoring CTPA utilization.

Main Methods:

• Electronic health records from two academic hospitals were queried for ED CTPA orders.
• CTPA orders were linked to inpatient discharge diagnoses of PE using ICD codes.
• A computerized method calculated CTPA yield, which was validated against manual chart reviews by independent reviewers.

Main Results:

• A total of 349 CTPA orders were analyzed, with 28 positive for acute PE, yielding a CTPA yield of 7.7%.
• The computerized method correctly identified 27 out of 28 PE-positive scans.
• One discordant case involved a patient discharged directly from the ED without an inpatient diagnosis.

Conclusions:

• This study successfully validated a computerized method for calculating CTPA yield in the ED.
• The computerized approach is more efficient and accurate than manual chart review for data extraction.
• This method enables healthcare systems to monitor CTPA appropriateness, reduce overuse, and minimize preventable iatrogenic harm.