TY - JOUR T1 - Improving the diagnostic yield of PE using the BTS pathway: The experience of a UK district general hospital JF - European Respiratory Journal JO - Eur Respir J VL - 38 IS - Suppl 55 SP - p3937 AU - Craig Batista AU - Timothy Ho Y1 - 2011/09/01 UR - http://erj.ersjournals.com/content/38/Suppl_55/p3937.abstract N2 - In 2003, the British Thoracic Society developed an algorithm for investigating PE, based on risk stratification (low, intermediate and high), selected D-Dimer use and Computed Tomography Pulmonary Angiography (CTPA). For low and intermediate patients a negative D-Dimer is reliable in excluding PE, avoiding unnecessary irradiation. Despite this, the positive diagnostic yield within our organisation remains below 25%. To understand this low yield, we carried out a retrospective analysis of medical patients who underwent CTPA during November 2010.Method: The medical records of all patients admitted with suspected PE who underwent CTPA were analysed. Each patient's risk was retrospectively scored according to BTS guidance and adherence to the BTS diagnostic pathway was noted.Results: 37 patients underwent CTPA; 15 low, 14 intermediate and 8 high probability. 7 had PE (total 19%): 1 low (7%), 3 intermediate (21%) and 3 high probability (38%). A total of 5 low and intermediate patients did not have a D-Dimer before CTPA despite this being indicated. Of these, 4 did not have PE. Additionally, 3 intermediate patients underwent CTPA despite a negative D-dimer; none had PEs. 10 had no documented clinical features of PE (e.g. tachypnoea, tachycardia, hypoxaemia, shock, signs of right ventricular strain or unilateral leg swelling). 4 low and 5 intermediate probability patients had abnormal chest x-rays which retrospectively accounted for their symptoms (36%). In total, 18 patients (49%) followed a diagnostic route deviating from the BTS pathway.Discussion: Our study suggests that adherence to BTS guidance may improve diagnostic rates for PE and reduce the number of inappropriate CTPAs. ER -