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

David Mountain, Gerben Keijzers, Kevin Chu, Anthony Joseph, Catherine Read, Gabriel Blecher, Jeremy Furyk, Chrianna Bharat, Karthik Velusamy, Andrew Munro, Kylie Baker, Frances Kinnear, Ahses Mukherjee, Gina Watkins, Paul Buntine, Georgia Livesay, Daniel Fatovich

Research output: Contribution to journalArticle

10 Citations (Scopus)

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

Original languageEnglish
Article numbere0166483
Pages (from-to)1-15
Number of pages15
JournalPLoS One
Volume11
Issue number12
DOIs
Publication statusPublished - 1 Dec 2016

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Radiology
embolism
observational studies
Embolism
Observational Studies
Hospital Emergency Service
Angiography
lungs
Lung
radiology
Pulmonary Embolism

Cite this

Mountain, David ; Keijzers, Gerben ; Chu, Kevin ; Joseph, Anthony ; Read, Catherine ; Blecher, Gabriel ; Furyk, Jeremy ; Bharat, Chrianna ; Velusamy, Karthik ; Munro, Andrew ; Baker, Kylie ; Kinnear, Frances ; Mukherjee, Ahses ; Watkins, Gina ; Buntine, Paul ; Livesay, Georgia ; Fatovich, Daniel. / 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. In: PLoS One. 2016 ; Vol. 11, No. 12. pp. 1-15.
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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",
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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. / Mountain, David; Keijzers, Gerben; Chu, Kevin; Joseph, Anthony; Read, Catherine; Blecher, Gabriel; Furyk, Jeremy; Bharat, Chrianna; Velusamy, Karthik; Munro, Andrew; Baker, Kylie; Kinnear, Frances; Mukherjee, Ahses; Watkins, Gina; Buntine, Paul; Livesay, Georgia; Fatovich, Daniel.

In: PLoS One, Vol. 11, No. 12, e0166483, 01.12.2016, p. 1-15.

Research output: Contribution to journalArticle

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T2 - 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

AU - Mountain, David

AU - Keijzers, Gerben

AU - Chu, Kevin

AU - Joseph, Anthony

AU - Read, Catherine

AU - Blecher, Gabriel

AU - Furyk, Jeremy

AU - Bharat, Chrianna

AU - Velusamy, Karthik

AU - Munro, Andrew

AU - Baker, Kylie

AU - Kinnear, Frances

AU - Mukherjee, Ahses

AU - Watkins, Gina

AU - Buntine, Paul

AU - Livesay, Georgia

AU - Fatovich, Daniel

PY - 2016/12/1

Y1 - 2016/12/1

N2 - 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

AB - 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

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