Implementation of a clinical prediction tool for pulmonary embolism diagnosis in a tertiary teaching hospital reduces the number of computed tomography pulmonary angiograms performed.
OBJECTIVE
To evaluate the effect of implementing the Wells score clinical prediction tool (CPT) on rationalising the use of computed tomography pulmonary angiography (CTPA) for diagnosing pulmonary embolism (PE).


METHODS
Within a tertiary teaching hospital, a retrospective study was conducted applying Wells score to all CTPA ordered in the first quarter of 2007. Subsequently, an algorithm including Wells score and d-dimer assay was developed to assist clinicians in rationalising their ordering of CTPA. A prospective study was performed from February to August 2009 to assess the impact of this algorithm. CTPA results, d-dimer levels, referral sources and dates were recorded. The number of CTPA performed over a 7-month period following implementation of the algorithm was compared with the same period during the previous year. PE prevalence within each risk category was compared with the published literature.


RESULTS
Three hundred and thirty-three patients were investigated with CTPA in the prospective study period. Two hundred and sixty-eight patients (80.4% of cases) had complete data. The prevalence of PE in the present study was 13.8% with 57 (21.2%) patients stratified to low risk, 169 (63.0%) to intermediate risk and 42 (15.6%) to high risk. Subgroup prevalence was 8.8%, 11.8% and 23.8% respectively. Compared with the same period in 2008, 121 (26.6%) less CTPA were performed.


CONCLUSIONS
Institutional implementation of a clinical prediction tool into the decision-making process is feasible and significantly reduces the number of CTPA being performed, with substantial cost savings and patient benefits.
Department of Respiratory and Sleep Medicine, Monash Medical Centre, Southern Health, Melbourne, Victoria, Australia. chong.ong@southernhealth.org.au
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CW
Ong
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Malipatil
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Lavercombe
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Teo
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Coughlin
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Leach
M C
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Spanger
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Thien
D006784:Hospitals, Teaching / Q000639:trends; D006801:Humans; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000639:trends; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data* / Q000639:trends