Abstract
Introduction: The British Thoracic Society (BTS) advise that patients with suspected PE should have a pre test probability (PTP) before requesting CTPA. A low or moderate PTP combined with a negative D Dimer excludes PE in over 97% of cases. In May 2012 an audit of the management of suspected PE was conducted with education measures.
Objectives: To assess whether there is an improvement in CTPA requesting.
Methods: We conducted a retrospective audit of inpatient CTPA requests, between August and December 2012.
Results: 289 CTPAs were performed. 12(4%) patients had a documented PTP. 214(74%) had documented clinical information considered as part of their risk stratification. In May 2012, 9/42 (24%) patients had a documented PTP. 236(82%) patients had an appropriate D dimer requested, in comparison to 64% previously. The following tables show the PPV of the Wells score and the predictive value of the D dimer in our study.
Conclusion: As a Trust,we are recording PTP even less than before; resulting in inappropriate CTPA requests. D dimer requesting has improved. These measures have a good predictive value in our study. Overall, the use of the BTS guidelines has improved with education. However revision of this is necessary in order to maintain a high standard of care.
- © 2013 ERS