Utilization patterns and diagnostic yield of 3421 consecutive multidetector row computed tomography pulmonary angiograms in a busy emergency department.
OBJECTIVE
To compare examination volume and diagnostic yield of computed tomography (CT) pulmonary angiography (CTPA) and ventilation-perfusion (V/Q) scintigraphy for detection of suspected pulmonary embolism (PE) in emergency department patients.


METHODS
Every CTPA and V/Q scan result for emergency department patients between October 2001 and September 2005 were reviewed. Patients with prior PE and follow-up examinations were excluded.


RESULTS
A total of 3421 CTPA examinations and 198 V/Q scans met inclusion criteria. Average CTPA examinations completed per month increased 227%, from 33.4 to 109.2 for the first and last 24-month periods, respectively. Ventilation-perfusion scintigraphy volume decreased 80% (from 6.9 to 1.4 per month). Total diagnoses of PE per month increased 89% from 4.0 to 7.5, whereas the percentage of positive CTPA examinations dropped from 9.8% to 6.8%.


CONCLUSIONS
Availability of CT in the emergency department and lower physician thresholds for test utilization have increased the use of CT pulmonary angiography and increased detection of PE.
Brown Medical School, Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA. donohoo33@yahoo.com
Jay H
JH
Donohoo
William W
WW
Mayo-Smith
John A
JA
Pezzullo
Thomas K
TK
Egglin
D000792:Angiography / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D006801:Humans; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D012237:Rhode Island; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*