ArticleAnnals of thoracic medicine
Suboptimal implementation of diagnostic algorithms and overuse of computed tomography-pulmonary angiography in patients with suspected pulmonary embolism.
Article in Annals of thoracic medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- 2017 Update on Medical Overuse: A Systematic Review.JAMA internal medicine · 2018Pooled it
- Development and validation of an explainable machine learning model for risk stratification in patients with clinically suspected acute pulmonary embolism: retrospective study.Clinics (Sao Paulo, Brazil) · 2026Article
- Investigation of suspected pulmonary embolus - Imaging frequency and diagnostic yield over 10 years in a major UK teaching hospital.Clinical medicine (London, England) · 2026Article
- Clinical characteristics and BGA-optimized pretest probability of pulmonary embolism in the elderly.Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Article
- Impact of a Clinical Decision Support System on CT Pulmonary Angiography Yield and Utilization in Hospitalized Patients.Journal of the American College of Radiology : JACR · 2025Article
- Deployment of a human-centred clinical decision support system for pulmonary embolism: evaluation of impact on quality of diagnostic decisions.BMJ open quality · 2024Article
- 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
- The diagnostic potential of plasma SCUBE-1 concentration for pulmonary embolism: A pilot study.The clinical respiratory journal · 2023Article
- Diagnostic approach and use of CTPA in patients with suspected pulmonary embolism in an emergency department in Saudi Arabia.Blood research · 2023Article
- Application of the pulmonary embolism rule-out criteria (PERC rule) and age-adjusted D-Dimer in patients undergoing computed tomography pulmonary angiography for diagnosis of pulmonary embolism.Jornal vascular brasileiro · 2023Article
- The application of an age adjusted D-dimer threshold to rule out suspected venous thromboembolism (VTE) in an emergency department setting: a retrospective diagnostic cohort study.BMC emergency medicine · 2022Article
- PrEdictive value of coMbined pre-test proBability and blOod gas anaLysis In pulmonary emboliSM-the EMBOLISM study.Internal and emergency medicine · 2022Article
- Variation in Positivity Rates of Computed Tomography Pulmonary Angiograms for the Evaluation of Acute Pulmonary Embolism Among Emergency Department Physicians.The Permanente journal · 2022Article
- Diagnosing pulmonary thromboembolism: Concerns and controversies.Medical journal, Armed Forces India · 2022Review
- Serial use of existing clinical decisions aids can reduce computed tomography pulmonary angiography for pulmonary embolism.Internal and emergency medicine · 2021Article
- Role of a new age-adjusted D-dimer cutoff value for preoperative deep venous thrombosis exclusion in elderly patients with hip fractures.Journal of orthopaedic surgery and research · 2021Article
- Utilization of serum D-dimer assays prior to computed tomography pulmonary angiography scans in the diagnosis of pulmonary embolism among emergency department physicians: a retrospective observational study.BMC emergency medicine · 2021Observational
- Provider Perspectives on the Use of Evidence-based Risk Stratification Tools in the Evaluation of Pulmonary Embolism: A Qualitative Study.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2020Article
- Ancillary Findings on CT Pulmonary Angiograms that are Negative for Pulmonary Embolism.Spartan medical research journal · 2020Article
- Development and Performance of the Pulmonary Embolism Result Forecast Model (PERFORM) for Computed Tomography Clinical Decision Support.JAMA network open · 2019Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMajority of our computed tomography-pulmonary angiography (CTPA) scans report negative findings. We hypothesized that suboptimal reliance on diagnostic algorithms contributes to apparent overuse of this test.
methodsA retrospective review was performed on 2031 CTPA cases in a large hospital system. Investigators retrospectively calculated pretest probability (PTP). Use of CTPA was considered as inappropriate when it was ordered for patients with low PTP without checking D-dimer (DD) or following negative DD.
resultsAmong the 2031 cases, pulmonary embolism (PE) was found in 7.4% (151 cases). About 1784 patients (88%) were considered "PE unlikely" based on Wells score. Out of those patients, 1084 cases (61%) did not have DD test prior to CTPA. In addition, 78 patients with negative DD underwent unnecessary CTPA; none of them had PE.
conclusionsThe suboptimal implementation of PTP assessment tools can result in the overuse of CTPA, contributing to ineffective utilization of hospital resources, increased cost, and potential harm to patients.
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