Diagnostic yield of computed tomographic pulmonary angiography for suspected pulmonary embolism varies across settings w
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ORIGINAL ARTICLE
Diagnostic yield of computed tomographic pulmonary angiography for suspected pulmonary embolism varies across settings within a community-based health system Joshua Kornblum 1 & Reza J. Daugherty 2
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Richard Bounds 3
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Ansar Z. Vance 4
&
Assaf Graif 5
Received: 29 July 2020 / Accepted: 27 September 2020 # American Society of Emergency Radiology 2020
Abstract Purpose The diagnostic yield of computed tomographic pulmonary angiography (CTPA) for pulmonary embolism varies in the literature, and very little data is available regarding community-based systems. This study evaluates the yield of CTPA for pulmonary embolism across a variety of patient care settings in a community-based healthcare system, providing relevant benchmarks for potential quality improvement efforts. Methods This retrospective study included data collected from three sites within a single community-based healthcare system, including a tertiary care level 1 trauma center, an urban community hospital, and a suburban free-standing emergency department. CTPAs were identified by Current Procedural Terminology codes, and diagnoses of pulmonary embolism were identified via International Classification of Diseases codes. A total of 7850 CTPA studies met criteria for inclusion between January 1, 2012, and October 8, 2014. Results Pulmonary embolism was found in 884 (11.3%) of the studies performed. Outpatients had a lower yield of pulmonary embolism (3.8%, p < 0.001) compared with inpatients (14.1%) and emergency department patients (10.7%, p < 0.001). Patients with diagnoses of deep vein thrombosis or neoplasm had increased incidence of pulmonary embolism when compared with patients without these diagnoses (p < 0.001 for both). Conclusion The overall yield of CTPA for pulmonary embolism in this community-based system was similar to that at academic centers. The yield was significantly lower in the outpatient setting compared with studies originating in the emergency department or inpatient setting. Keywords Quality improvement . Pulmonary embolism . Computed tomography pulmonary angiography . Community-based healthcare system . Diagnostic yield
Introduction * Assaf Graif [email protected] 1
Department of Diagnostic Radiology, ChristianCare Health System, Newark, DE, USA
2
Department of Medical Imaging, Division of Pediatric Radiology, University of Virginia, Charlottesville, VA, USA
3
Division of Emergency Medicine, Department of Surgery, University of Vermont Medical Center, Burlington, VT, USA
4
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
5
Department of Vascular and Interventional Radiology, ChristianaCare Health System, 4755 Ogletown-Stanton Rd., Ste 1E20, Newark, DE 19718, USA
Computed tomographic pulmonary angiography (CTPA) has become the gold standard for the diagnosis of pulmonary embolism (PE) due to its established high sensitivity and specificity, widespread availability, speed of diagnosis, and potentia
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