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Congress: ECR24
Poster Number: ESI-17701
Type: EuroSafe Imaging Poster
DOI: 10.26044/ecr2024/ESI-17701
Authorblock: V. Maliakel, P. Foran; Dublin/IE
Disclosures:
Venus Maliakel: Nothing to disclose
Paul Foran: Nothing to disclose
Keywords: Lung, Pulmonary vessels, Thorax, CT, CT-Angiography, Audit and standards, Contrast agent-intravenous, Diagnostic procedure, Embolism / Thrombosis
Purpose or learning objective CTPA is currently considered to be the gold standard imaging utilised when detecting pulmonary emboli. As such, it can be ordered inappropriately and results in patients being exposed to unnecessary radiation.An audit to assess compliance of the guidelines when ordering CTPA for suspected pulmonary emboli was conducted from July 2017-September 2017 in the Department of Radiology in Connolly Hospital Blanchardstown (Dublin, Ireland). This re-audit reviews data from January – March 2023 and aims to assess if compliance with the latest...
Read more Methods or background According to the British Thoracic Society, CTPA has a higher specificity for detecting pulmonary emboli, and is the preferred method of imaging over ventilation-perfusion isotope scans and pulmonary angiography. Although the latest generation of multi-slice scanners enable clinicians to correlate the severity of patient symptoms to the clot burden, subsegmental clots are more difficult to detect. Better techniques for image requisition and advanced CT technology allows for more accurate detection of peripheral pulmonary emboli (British Thoracic Society, 2003). Most hospitals in...
Read more Results or findings The scans requests and reports of 146 patients who had CTPA were reviewed. This was compared to the previous audit results of 93 patients (results of each audit on Figures 1, 2, 3).132/146 (90.4%) patients had a Well’s score documented, compared to 27/93 (29%) patients in the previous audit. 102/146 (69.9%) patients had a D-dimer performed and documented, in comparison to the 78/93 (83.8%) patients in the previous audit. 6/54 (11.1%) patients who had a Well’s score of 4 and...
Read more Conclusion From the results of the re-audit, it can be concluded that while the uptake for utilising risk stratification tools such as the Well’s score had improved from 29% to 90.4%, performing and documenting D-dimer results had decreased (83.8% to 69.9%).11.1% (6/54) requests did not follow the guidelines that recommended that D-dimer be performed in patients who have a Well’s score below 4. It is unknown whether these patients were anticoagulated whilst awaiting CTPA, as recommended by the (NICE guideline, 2023)....
Read more References British Thoracic Society, 2003. British Thoracic Society guidelines for the managment of suspected acute pulmonary embolism. Thorax, Volume 58, pp. 470-483.NICE guideline, 2023. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. [Online] Available at: https://www.nice.org.uk/guidance/ng158[Accessed 08 September 2023].
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