ArticleJournal of the American College of Radiology : JACR2019
An Evaluation of Guideline-Discordant Ordering Behavior for CT Pulmonary Angiography in the Emergency Department.
Article in Journal of the American College of Radiology : JACR, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Overuse of imaging for pulmonary embolism in emergency departments: a systematic review and meta-analysis.International journal of emergency medicine · 2026Review
- Exploring Patterns of D-Dimer Assay Ordering at an Australian Rural Referral Hospital: A Retrospective Audit.Emergency medicine Australasia : EMA · 2026Article
- How Tasmanian Emergency Departments 'Choose Wisely' When Investigating Suspected Pulmonary Embolism.Healthcare (Basel, Switzerland) · 2023Article
- Comparing 'clinical hunch' against clinical decision support systems (PERC rule, wells score, revised Geneva score and YEARS criteria) in the diagnosis of acute pulmonary embolism.BMC pulmonary medicine · 2022Article
- Low-value pharmaceutical care among Dutch GPs: a retrospective cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022Article
- Use of Computed Tomography Pulmonary Angiography in Emergency Departments: A Literature Review.Healthcare (Basel, Switzerland) · 2022Review
- Barriers to the Use of Clinical Decision Support for the Evaluation of Pulmonary Embolism: Qualitative Interview Study.JMIR human factors · 2021Article
- Physician choices in pulmonary embolism testing.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2021Article
- Effectiveness of Clinical Decision Tools in Predicting Pulmonary Embolism.Pulmonary medicine · 2021Article
- Higher Imaging Yield When Clinical Decision Support Is Used.Journal of the American College of Radiology : JACR · 2020Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
purposeThe aim of this study was to determine rates of and possible reasons for guideline-discordant ordering of CT pulmonary angiography for the evaluation of suspected pulmonary embolism (PE) in the emergency department.
methodsA retrospective review was performed of 212 consecutive encounters (January 6, 2016, to February 25, 2016) with 208 unique patients in the emergency department that resulted in CT pulmonary angiography orders. For each encounter, the revised Geneva score and two versions of the Wells criteria were calculated. Each encounter was then classified using a two-tiered risk stratification method (PE unlikely versus PE likely). Finally, the rate of and possible explanations for guideline-discordant ordering were assessed via in-depth chart review.
resultsThe frequency of guideline-discordant studies ranged from 53 (25%) to 79 (37%), depending on the scoring system used; 46 (22%) of which were guideline discordant under all three scoring systems. Of these, 18 (39%) had at least one patient-specific factor associated with increased risk for PE but not included in the risk stratification scores (eg, travel, thrombophilia).
conclusionsMany of the guideline-discordant orders were placed for patients who presented with evidence-based risk factors for PE that are not included in the risk stratification scores. Therefore, guideline-discordant ordering may indicate that in the presence of these factors, the assessment of risk made by current scoring systems may not align with clinical suspicion.
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