title: Could the number of CT angiograms be reduced in emergency department patients suspected of pulmonary embolism?
abstract: BACKGROUND
  This study was undertaken to identify the prevalence of pulmonary embolism (PE) in the emergency department (ED) of an urban teaching hospital and also to test a Bayesian model in estimating the number of CT pulmonary angiography (CTA) expected to be performed in an emergency department.
  
  
  METHODS
  The data for this study was obtained through a retrospective review of electronic medical records for all ED patients suspected of PE who underwent chest CTA or ventilation perfusion scanning (V/Q) between 2009 and 2010. The data is presented as means and standard deviation for continuous variables and percentages with 95% confidence intervals (95%CI) for proportions. The prevalence of PE was used as pre-test probability in the Bayesian model. Post-test probability was obtained using a Fagan nomogram and likelihood ratios for CTA.
  
  
  RESULTS
  A total of 778 patients (560 females) with mean age of 50 years (range 18-98 years) were enrolled (98.3% underwent chest CTA and 1.7% underwent V/Q scan). A total of 69 patients had PE, rendering an overall prevalence of 8.9% (95%CI, 7.1% to 11.1%) for PE. We calculated that 132 CTA's per year could be avoided in our institution, without compromising safe exclusions of PE (keeping post-test probability of PE below 2%).
  
  
  CONCLUSIONS
  Despite differences in our patient populations and /or study designs, the prevalence of PE in our institution is about average compared to other institutions. Our proposed model for calculating redundant chest CTA is simple and can be used by institutions to identify overuse of CTA.
authors.affiliation: Department of Emergency Medicine, Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Zehtabchi
authors.initials: Z
authors.lastname: Shahriar
authors.affiliation: Department of Emergency Medicine, Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Rinnert
authors.initials: R
authors.lastname: Stephan
authors.affiliation: Department of Emergency Medicine, Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Malhotra
authors.initials: M
authors.lastname: Shweta
authors.affiliation: Department of Emergency Medicine, Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Subramanian
authors.initials: S
authors.lastname: Arun
authors.affiliation: Department of Emergency Medicine, Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Timberger
authors.initials: T
authors.lastname: Mathew
authors.affiliation: Department of Emergency Medicine, George Washington University Medical Center, Washington, DC, USA.
authors.forename: Patel
authors.initials: P
authors.lastname: Brijal
authors.affiliation: Department of Emergency Medicine, Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Toro
authors.initials: T
authors.lastname: David
authors.affiliation: Department of Emergency Medicine, Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Khaled
authors.affiliation: Department of Emergency Medicine, Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Sinert
authors.initials: S
authors.lastname: Richard
keywords: CT pulmonary angiography; Emergency; Pulmonary embolism