Abstract and Introduction
One third of imaging studies for suspected pulmonary embolism were potentially avoidable according to the National Quality Forum performance measure.
Most algorithms for management of suspected pulmonary embolism (PE) recommend D-dimer testing for patients with low pretest probability of disease (Wells score <2), with no further testing if D-dimer is negative and computed tomography (CT) scanning if D-dimer is positive. To determine the frequency of potentially avoidable imaging, researchers examined the charts of 3710 hemodynamically stable patients who presented to the emergency departments (EDs) of 12 U.S. hospitals (10 teaching and 2 community) and whose attending physicians ordered CT or ventilation/perfusion scans to evaluate for PE. In accordance with the National Quality Forum measure, imaging was considered potentially avoidable if it was performed on hemodynamically stable, low-risk patients in whom D-dimer tests were either negative or not ordered.
Overall, 32% of imaging tests met the definition of potentially avoidable; in two thirds of these cases, D-dimer testing had not been performed. Predictors of imaging in the absence of D-dimer testing were older age, pregnancy, and sickle cell disease — factors known to be associated with a positive D-dimer test. Imaging identified PE in 1.5% of low-risk patients with negative D-dimer results or no testing. The authors did not describe the location or severity of the clots or outcomes.
Journal Watch © 2012 Massachusetts Medical Society