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Insights into Imaging
Published in: Insights into Imaging 5/2016

Open Access 01-10-2016 | Original Article

Mandatory adherence to diagnostic protocol increases the yield of CTPA for pulmonary embolism

Authors: Stefan Walen, Erwin de Boer, Mireille A. Edens, Corné A. J. van der Worp, Martijn F. Boomsma, Jan Willem K. van den Berg

Published in: Insights into Imaging | Issue 5/2016

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Abstract

Objectives

To determine if mandatory adherence to a diagnostic protocol increases the rate of computed tomography pulmonary angiographies (CTPAs) positive for pulmonary embolism (PE)—the so-called diagnostic yield. Further, we aim to identify factors associated with this diagnostic yield.

Methods

We included all patients with suspected PE requiring CTPA from 9 January 2014 t0 3 June 2014. The requesting physicians were forced to follow diagnostic workup for PE by calculating a Wells score and, if necessary, determining D-dimer level. The percentage of positive CTPA scans was calculated and compared with our previous cohort (Walen et al. Insights Imaging 2014;5(2):231–236). Odds ratios were calculated as a measure of association between dichotomous variables and CTPA findings.

Results

Of 250 scans, 74 were positive (29.6 % [95 % CI, 24.3-35.5 %]) and 175 were negative (70 %). The percentage positive scans increased with 6.6 % and the percentage negative scans decreased with 3.1 %. This change was statistically significant (p = 0.001). Independent clinical predictors of diagnostic yield were previous deep venous thrombosis (DVT) (OR, 3.22; p = 0.013) and clinical signs of DVT (OR, 2.71; p = 0.012). Chronic obstructive pulmonary disease (COPD) was negatively associated with PE (OR, 0.33; p = 0.045).

Conclusions

This study shows that mandatory adherence to a diagnostic protocol increases the yield of CTPA for PE in our centre.

Main Messages

• Mandatory adherence to diagnostic protocol increases the yield of CTPA for PE
• Previous DVT and signs of DVT were associated with a higher yield
• No patients with a low Wells score and a low D-dimer had PE
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Metadata
Title
Mandatory adherence to diagnostic protocol increases the yield of CTPA for pulmonary embolism
Authors
Stefan Walen
Erwin de Boer
Mireille A. Edens
Corné A. J. van der Worp
Martijn F. Boomsma
Jan Willem K. van den Berg
Publication date
01-10-2016
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 5/2016
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1007/s13244-016-0509-2

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