PT  - JOURNAL ARTICLE
AU  - Sophia Antoniou
AU  - Hsiu Tung
AU  - Shelley Srivastava
TI  - A prospective study: Are CTPAs requested appropriately and if not do they diagnose alternative pathologies?
DP  - 2014 Sep 01
TA  - European Respiratory Journal
PG  - P665
VI  - 44
IP  - Suppl 58
4099  - http://erj.ersjournals.com/content/44/Suppl_58/P665.short
4100  - http://erj.ersjournals.com/content/44/Suppl_58/P665.full
SO  - Eur Respir J2014 Sep 01; 44
AB  - IntroductionComputerised Tomography Pulmonary Angiogram (CTPA) is routinely used to investigate suspected pulmonary embolism (PE).PEs are clinically difficult to diagnose and associated with significant morbidity and mortality. Clinical concern and the increased availability of CTPA may mean more patients receive unnecessary radiation: a CTPA is approximately 750 chest radiographs[1]. In addition, detection of other pathology by CTPA often has minimal clinical impact[2].AimsTo investigate our compliance with NICE guidelines in ordering CTPAs, and whether detecting alternative diagnoses justifies their use.MethodsThis prospective study, in a London teaching hospital, reviewed data in all medical and oncology patients who had a CTPA in January 2014. Clinical diagnoses and risk scores were recorded according to national guidelines.ResultsA CTPA was carried out on 49 patients (66% female); 10 had confirmed PE (20%). In 31 (63%), guidelines were not followed: 27 did not have D-dimers. Of those with PE, 40% were detected despite low Wells Scores. In 19 (39%), an alternative diagnosis explaining the symptoms was shown: 8 on CTPA, but only 6 resulted in a management change. Incidental findings were made in 6 requiring follow-up.ConclusionsPEs remain difficult to diagnose. Clinical skills may not be accurate, our detection rate was 20%, and 40% had a low Wells score. A better scoring system may be required. In addition, alternative diagnoses for CTPA do not appear to alter management in the majority. More research is required in diagnosing PE to minimise radiation and contrast risks, and ensure CTPAs are of maximum clinical benefit.[1] BMJ 2011;342:d947[2] Chest 2013;144(6):1893-9.