Nav: Home

Physician adherence to clinical decision tools suggests potential benefit to PE patients

March 23, 2017

Leesburg, VA, March 22, 2017-- A review paper published in the American Journal of Roentgenology (AJR) suggests a potential benefit to the use of clinical decision tools in the diagnostic work-up of suspected pulmonary embolism (PE) patients. The finding could impact the traditional use of pulmonary CT angiography (CTA) as the imaging modality of choice for evaluating patients believed to suffer from PE.

The study titled "Role of Clinical Decision Tools in the Diagnosis of Pulmonary Embolism" indicates that despite the increased use of pulmonary CTA, the diagnostic yield remains low. Dr. William M. Sherk and Dr. Jadranka Stojanovska, both from University of Michigan Health Systems, Ann Arbor, authored the paper which is available for viewing on the AJR website accessible here.

"While pulmonary CTA is desirable as a test for suspected PE, the binary yes or no answer to a challenging diagnosis with ambiguous clinical presentation is enticing," said Stojanovska. "As with other diagnostic tests, however, the posttest probability of pulmonary CTA hinges on pretest clinical assessment."

"Validated clinical decision rules and integrated clinical decision support (CDS) systems can influence the appropriate use of pulmonary CTA, but further investigation is required to define the most successful means of integration into clinical practice," Stojanovska said.

PE is a frequently suspected diagnosis, especially in patients appearing in emergency departments with cardiopulmonary symptoms. The study suggests that CTA is overused as a screening rather than a diagnostic examination, which increases financial costs and medical consequences from radiation exposure and the use of contrast media.

Clinical decision rules were developed to determine which patients would benefit from further diagnostic work-up such as pulmonary CTA. Unfortunately, according to the study, the moderate impact of CDS on pulmonary CTA use and yield is related to physician nonadherence, an issue that is not unique.

Electronic clinical decision rules or support systems are cumbersome and require added input by the ordering clinician. Distrust of standardized rules, fear of legal retribution if a morbid or fatal PE is missed, and unfamiliarity with radiation exposure and iodinated contrast risks all further detract from successful implementation. Patient input also factors into nonadherence; some patients with particular symptoms may request CT for evaluation. Clinicians may assume that in the absence of PE an alternative diagnosis will be established with pulmonary CTA, despite evidence that different etiologic factors are supported in only one-third of cases.

According to the study, single or limited educational intervention is not as likely to help overcome these obstacles as repetitive educational efforts up to five years.
Founded in 1900, ARRS is the first and oldest radiology society in the United States, and is an international forum for progress in radiology. The Society's mission is to improve health through a community committed to advancing knowledge and skills in radiology. ARRS achieves its mission through an annual scientific and educational meeting, publication of the American Journal of Roentgenology (AJR) and InPractice magazine, topical symposia and webinars, and print and online educational materials. ARRS is located in Leesburg, VA.

American Roentgen Ray Society

Related Pulmonary Embolism Articles:

SNMMI publishes appropriate use criteria for V/Q imaging in pulmonary embolism
The Society of Nuclear Medicine and Molecular Imaging has published appropriate use criteria for ventilation/perfusion (V/Q) imaging in pulmonary embolism.
Antibody is effective against radiation-induced pulmonary fibrosis
Radiation therapy of the lungs often leads to irreversible connective-tissue changes that cause functional impairments in the pulmonary tissue.
Long-term limitations imposed on patients with pulmonary embolism
A multi-centre clinical study, led by Dr. Susan Kahn at the Jewish General Hospital (JGH), determined that nearly half of the patients who suffer a pulmonary embolism (PE) -- a blood clot in the lung -- experience long term limitations to their capacity for physical activity and that this had a negative impact on their quality of life.
High-risk pulmonary embolism patients often go without most effective treatments
In a new study presented today at the American College of Cardiology 66th Annual Scientific Session, researchers from the Perelman School of Medicine at the University of Pennsylvania have found that the utilization rates of these potentially life-saving medications are low, particularly in the sub-group of PE patients who are critically ill.
Sleep apnea can contribute to recurring pulmonary embolism
Researchers have found that after the first incidence of pulmonary embolism (PE), obstructive sleep apnea increases the risk for PE recurrence.
More Pulmonary Embolism News and Pulmonary Embolism Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Teaching For Better Humans
More than test scores or good grades — what do kids need to prepare them for the future? This hour, guest host Manoush Zomorodi and TED speakers explore how to help children grow into better humans, in and out of the classroom. Guests include educators Olympia Della Flora and Liz Kleinrock, psychologist Thomas Curran, and writer Jacqueline Woodson.
Now Playing: Science for the People

#535 Superior
Apologies for the delay getting this week's episode out! A technical glitch slowed us down, but all is once again well. This week, we look at the often troubling intertwining of science and race: its long history, its ability to persist even during periods of disrepute, and the current forms it takes as it resurfaces, leveraging the internet and nationalism to buoy itself. We speak with Angela Saini, independent journalist and author of the new book "Superior: The Return of Race Science", about where race science went and how it's coming back.