ArticleIntensive care medicine2012
Ordering CT pulmonary angiography to exclude pulmonary embolism: defense versus evidence in the emergency room.
Article in Intensive care medicine, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 59 citations in OpenAlex.
- How defensive medicine is defined in European medical literature: a systematic review.BMJ open · 2022Pooled it
- Overuse of imaging for pulmonary embolism in emergency departments: a systematic review and meta-analysis.International journal of emergency medicine · 2026Review
- Computed Tomography Yield and Predictors of Pulmonary Embolism in Mechanically Ventilated Patients-A Retrospective Study.Acta anaesthesiologica Scandinavica · 2026Article
- Trends in CT pulmonary angiography utilization and recurrent imaging in sickle cell disease: a longitudinal study.International journal of emergency medicine · 2025Article
- Mycoplasma pneumoniae pneumonia-associated thromboembolism with plastic bronchitis: a series of five case reports and literature review.Italian journal of pediatrics · 2024Review
- Assessment of the Utilization of Validated Diagnostic Predictive Tools and D-Dimer in the Evaluation of Pulmonary Embolism: A Single-Center Retrospective Cohort Study from a Public Hospital in New York City.Journal of clinical medicine · 2023Article
- CTPA ordering trends in local emergency departments: are they increasing and did they increase as a result of COVID-19?Emergency radiology · 2023Article
- Diagnostic approach and use of CTPA in patients with suspected pulmonary embolism in an emergency department in Saudi Arabia.Blood research · 2023Article
- Use of Computed Tomography Pulmonary Angiography in Emergency Departments: A Literature Review.Healthcare (Basel, Switzerland) · 2022Review
- CT pulmonary angiography appropriateness in a single emergency department: does the use of revised Geneva score matter?La Radiologia medica · 2021Article
- Feasibility of a quality improvement project to increase adherence to evidence-based pulmonary embolism diagnosis in the emergency department.Pilot and feasibility studies · 2021Article
- Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study.BMJ quality & safety · 2020Article
- How defensive medicine is defined and understood in European medical literature: protocol for a systematic review.BMJ open · 2020Article
- Age-dependent diagnostic accuracy of clinical scoring systems and D-dimer levels in the diagnosis of pulmonary embolism with computed tomography pulmonary angiography (CTPA).European radiology · 2019Article
- Unenhanced multidetector computed tomography findings in acute central pulmonary embolism.BMC medical imaging · 2019Article
- Qualitative Study to Understand Ordering of CT Angiography to Diagnose Pulmonary Embolism in the Emergency Room Setting.Journal of the American College of Radiology : JACR · 2018Article
- The Economic Value of Hybrid Single-photon Emission Computed Tomography With Computed Tomography Imaging in Pulmonary Embolism Diagnosis.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2017Article
- Validation of the German version of two scales (RIS, RCS-HCP) for measuring regret associated with providing healthcare.Health and quality of life outcomes · 2017Article
- Role of D-Dimer testing in venous thromboembolism with concomitant renal insufficiency in critical care.Intensive care medicine · 2017Article
- Prospective evaluation of the ability of clinical scoring systems and physician-determined likelihood of appendicitis to obviate the need for CT.Emergency medicine journal : EMJ · 2016Observational
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo identify reasons for ordering computed tomography pulmonary angiography (CTPA), to identify the frequency of reasons for CTPA reflecting defensive behavior and evidence-based behavior, and to identify the impact of defensive medicine and of training about diagnosing pulmonary embolism (PE) on positive results of CTPA.
methodsPhysicians in the emergency department of a tertiary care hospital completed a questionnaire before CTPA after being trained about diagnosing PE and completing questionnaires.
resultsNine hundred patients received a CTPA during 3 years. For 328 CTPAs performed during the 1-year study period, 140 (43 %) questionnaires were completed. The most frequent reasons for ordering a CTPA were to confirm/rule out PE (93 %), elevated D-dimers (66 %), fear of missing PE (55 %), and Wells/simplified revised Geneva score (53 %). A positive answer for "fear of missing PE" was inversely associated with positive CTPA (OR 0.36, 95 % CI 0.14-0.92, p = 0.033), and "Wells/simplified revised Geneva score" was associated with positive CTPA (OR 3.28, 95 % CI 1.24-8.68, p = 0.017). The proportion of positive CTPA was higher if a questionnaire was completed, compared to the 2-year comparison period (26.4 vs. 14.5 %, OR 2.12, 95 % CI 1.36-3.29, p < 0.001). The proportion of positive CTPA was non-significantly higher during the study period than during the comparison period (19.2 vs. 14.5 %, OR 1.40, 95 % CI 0.98-2.0, p = 0.067).
conclusionReasons for CTPA reflecting defensive behavior-such as "fear of missing PE"-were frequent, and were associated with a decreased odds of positive CTPA. Defensive behavior might be modifiable by training in using guidelines.
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Registered trials
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