title: Use of computed tomographic pulmonary angiography for the diagnosis of pulmonary embolism; are we overdoing it?
abstract: BACKGROUND
  Computed tomographic pulmonary angiography (CTPA) is a gold standard test for the diagnosis of pulmonary embolism (PE), but is reported to be over prescribed. We performed this study to determine over prescription of CTPAs at a District General Hospital (DGH) in the United Kingdom. Our secondary aim was to establish a cause of its over-prescription.
  
  
  METHODS
  We retrospectively reviewed clinical data of all patients who underwent CTPAs during January 2011 to July 2013. Collected data included CTPA findings, clinical probability score, D-dimer results, chest x-ray (CXR) findings and patient's demographic data. A calculation of overall clinical probability (including initial and post CTPA values) and its cross analysis with D-dimer, CTPA and CXR findings was made.
  
  
  RESULTS
  Pulmonary embolism was positive in 5 (11.6%) cases. An Initial probability score was available in 16 (37.20%), and a D-dimer result was available in 33 (76.7%). Chest X-ray (CXR) was abnormal in 8 (18.6%). A coupling of total probability score with D-dimer results (CPPD) identified 10 (22.2%) potential over prescriptions. A further analysis of CPPD with CXR revealed a definite over prescription of 8 (18.6%), whereas it increased the number of an overall possible over prescription to 14 (32.6%).
  
  
  CONCLUSIONS
  The CTPAs are being over prescribed and the main reasons behind it are poor utilization of probability scoring systems, D-dimer rule and lack of interpretation of alternative diagnosis on CXRs.
authors.forename: Shahid
authors.initials: S
authors.lastname: Kalim
authors.forename: Muhammad Shakil
authors.initials: MS
authors.lastname: Akhtar
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data*; D006113:United Kingdom
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D