Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2021, 165(1):51-56 | DOI: 10.5507/bp.2020.049

Appropriateness of CT pulmonary angiograms according to current diagnostic guidelines based on risk stratification: A retrospective single-center study

Michal Buk^a,b,c, Fabian Rengier^a,d, Theresa Mokry^a, Johannes Riffel^e, Evangelos Giannitsis^e, Lars Kihm^f, Hana Malikova^b,g, Hans-Ulrich Kauczor^a,d, Oyunbileg von Stackelberg^a, Tim Frederik Weber^a

^a Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany

^b Department of Radiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic

^c Second Faculty of Medicine, Charles University, Prague, Czech Republic

^d Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany

^e Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany

^f Department of Endocrinology, University Hospital Heidelberg, Heidelberg, Germany

^g Institute of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic

Background and Aim. Assessment of appropriateness of CT pulmonary angiograms (CTPA) in patients with suspected pulmonary embolism (PE) is based on risk stratification algorithms such as simplified the Geneva Score (sGS) in combination with D-dimer blood tests. The aim of this study was to validate the diagnostic yield and appropriateness of CTPA examinations in accordance with 2014 European Society of Cardiology (ESC) guidelines.

Materials and Methods: Data from 155 outpatients who underwent CTPA for clinical suspicion of PE were gathered from the radiology information system (RIS) and the clinical information system (CIS). We assessed the presence of sGS items and D-dimer blood test results in RIS from CTPA request forms and from clinical documentation in CIS.

Results: Based on the RIS, there were 2.6% patients with high (sGS≥3) and 97.4% patients with low pre-test PE probability (sGS<3), and CTPA indication was formally comprehendible in 75.5% using sGS and D-dimer blood tests. Based on RIS and CIS data in combination, there were 41.3% patients with high and 58.7% patients with low pre-test PE probability, and CTPA indication was formally comprehendible in 88.4%. Using RIS and CIS in combination, PE probability was upgraded from low to high probability in 39.7% compared with RIS alone. In 12.9%, there was a lack of data in RIS for CTPA justification.

Conclusion: There is a high diagnostic yield when applying current diagnostic guidelines to our data. There was however a notable discrepancy between the data transferred to the CTPA request forms from the full clinical documentation, therefore not readily available for clinical decision making.

Keywords: clinical decision making, acute pulmonary embolism, diagnostic guidelines, D-Dimers, CT pulmonary angiography, CT examination justification

Received: May 31, 2020; Revised: August 21, 2020; Accepted: October 7, 2020; Prepublished online: October 22, 2020; Published: March 12, 2021  Show citation