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Appropriateness of CT pulmonary angiograms according to current diagnostic guidelines based on risk stratification: A
Michal Buk1,2,3, Fabian Rengier1,4, Theresa Mokry1
1Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.
Insights
Assessing CT pulmonary angiograms (CTPA) for pulmonary embolism (PE) requires accurate risk stratification. Full clinical data integration significantly improves CTPA appropriateness compared to radiology information system data alone.
Area of Science:
- Radiology
- Cardiology
- Medical Diagnostics
Background:
- Pulmonary embolism (PE) diagnosis relies on CT pulmonary angiograms (CTPA) guided by risk scores like the simplified Geneva Score (sGS) and D-dimer tests.
- Current guidelines, such as the 2014 European Society of Cardiology (ESC) recommendations, dictate the appropriate use of CTPA.
Purpose of the Study:
- To validate the diagnostic yield and appropriateness of CTPA examinations for suspected PE.
- To assess the impact of integrating clinical information system (CIS) data with radiology information system (RIS) data on CTPA appropriateness.
Main Methods:
- Retrospective analysis of 155 outpatients undergoing CTPA for suspected PE.
- Evaluation of simplified Geneva Score (sGS) items and D-dimer results using both RIS and CIS data.
- Comparison of CTPA indication comprehensibility and pre-test probability assessment between RIS alone and combined RIS/CIS data.
Main Results:
- CTPA indication was formally comprehensible in 75.5% of cases using RIS data alone, increasing to 88.4% when CIS data was included.
- Integrating CIS data upgraded PE probability from low to high in 39.7% of patients compared to RIS data alone.
- A significant discrepancy was noted between data on CTPA request forms and full clinical documentation, impacting decision-making.
Conclusions:
- Applying current diagnostic guidelines to the study data demonstrates a high diagnostic yield for CTPA.
- Incomplete data transfer from clinical documentation to CTPA request forms hinders appropriate clinical decision-making.
- Comprehensive data integration is crucial for accurate risk stratification and appropriate CTPA utilization.
Background And Aim:
Assessment of appropriateness of CT pulmonary angiograms (CTPA) in patients with suspected pulmonary embolism (PE) is based on risk stratification algorithms such as simplified the Geneva Score (sGS) in combination with D-dimer blood tests. The aim of this study was to validate the diagnostic yield and appropriateness of CTPA examinations in accordance with 2014 European Society of Cardiology (ESC) guidelines.
Materials And Methods:
Data from 155 outpatients who underwent CTPA for clinical suspicion of PE were gathered from the radiology information system (RIS) and the clinical information system (CIS). We assessed the presence of sGS items and D-dimer blood test results in RIS from CTPA request forms and from clinical documentation in CIS.
Results:
Based on the RIS, there were 2.6% patients with high (sGS≥3) and 97.4% patients with low pre-test PE probability (sGS<3), and CTPA indication was formally comprehendible in 75.5% using sGS and D-dimer blood tests. Based on RIS and CIS data in combination, there were 41.3% patients with high and 58.7% patients with low pre-test PE probability, and CTPA indication was formally comprehendible in 88.4%. Using RIS and CIS in combination, PE probability was upgraded from low to high probability in 39.7% compared with RIS alone. In 12.9%, there was a lack of data in RIS for CTPA justification.
Conclusion:
There is a high diagnostic yield when applying current diagnostic guidelines to our data. There was however a notable discrepancy between the data transferred to the CTPA request forms from the full clinical documentation, therefore not readily available for clinical decision making.
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