Investigating suspected acute pulmonary embolism - what are hospital clinicians thinking?
OBJECTIVE
To assess local clinical knowledge of the appropriate investigation of suspected acute pulmonary embolism (PE) and this compare with the 2003 British Thoracic Society (BTS) guidelines as a national reference standard.


METHODS
A clinical questionnaire was produced based on the BTS guidelines. One hundred and eight-six participants completed the questionnaires at educational sessions for clinicians of all grades, within a single NHS Trust. The level of experience amongst participants ranged from final year medical students to consultant physicians.


RESULTS
The clinicians were divided into four groups based on seniority: Pre-registration, Junior, Middle, and Senior. Forty-six point eight percent of all the clinicians correctly identified three major risk factors for PE and 25.8% recognized the definition of the recommended clinical probability score from two alternatives. Statements regarding the sensitivity of isotope lung imaging and computed tomography pulmonary angiography (CTPA) received correct responses from 41.4 and 43% of participants, respectively, whilst 81.2% recognized that an indeterminate ventilation-perfusion scintigraphy (V/Q) study requires further imaging. The majority of clinicians correctly answered three clinical scenario questions regarding use of D-dimers and imaging (78, 85, and 57.5%). There was no statistically significant difference between the four groups for any of the eight questions.


CONCLUSIONS
The recommended clinical probability score was unfamiliar to all four groups of clinicians in the present study, and the majority of doctors did not agree that a negative CTPA or isotope lung scintigraphy reliably excluded PE. However, questions based on clinical scenarios received considerably higher rates of correct responses. The results indicate that various aspects of the national guidelines on suspected acute pulmonary embolism are unfamiliar to many UK hospital clinicians. Further research is needed to identify methods to improve this situation, as both clinicians and radiologists have a duty to ensure that patients are appropriately investigated.
McQueen
A S
AS
Department of Radiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK. andrewmcqueen7@hotmail.com
Worthy
S
S
Keir
M J
MJ
D000208:Acute Disease; D000792:Angiography / Q000379:methods; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005338:Fibrin Fibrinogen Degradation Products; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis*; D011877:Radionuclide Imaging / Q000379:methods; D013337:Students, Medical / Q000523:psychology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D006113:United Kingdom
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D