Variation in the utilization and positivity rates of CT pulmonary angiography among emergency physicians at a tertiary academic emergency department

Emergency Radiology

Volumn 22, Issue 3, 2015, Pages 221-229

  Chen, Yingming Amy ^a   Gray, Bruce G ^a   Bandiera, Glen ^a   MacKinnon, David ^a   Deva, Djeven P ^a  

^a ST MICHAEL'S HOSPITAL   (Canada)

Author keywords

CT pulmonary angiogram; Inter physician variation; Pulmonary embolism; Test utilization

Indexed keywords

ACUTE CHOLECYSTITIS; ADULT; AGED; ARTICLE; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAM; COMPUTED TOMOGRAPHY SCANNER; COMPUTER PROGRAM; CONTROLLED STUDY; CROSS-SECTIONAL STUDY; EFFUSION; EMERGENCY PHYSICIAN; EMERGENCY WARD; ESOPHAGITIS; FEMALE; HUMAN; INCIDENCE; INTERSTITIAL LUNG DISEASE; LUNG ANGIOGRAPHY; LUNG EDEMA; LUNG EMBOLISM; LUNG INFECTION; LUNG NODULE; LUNG TUMOR; MAJOR CLINICAL STUDY; MALE; MIDDLE AGED; PHYSICIAN; PNEUMOTHORAX; PRIORITY JOURNAL; RETROSPECTIVE STUDY; THORAX RADIOGRAPHY; ANGIOGRAPHY; CLINICAL PRACTICE; COMPUTER ASSISTED TOMOGRAPHY; EMERGENCY HEALTH SERVICE; HOSPITAL; RADIOGRAPHY; STATISTICS AND NUMERICAL DATA; TERTIARY HEALTH CARE; UTILIZATION;

CONTRAST MEDIUM; IODIXANOL; IODOBENZOIC ACID DERIVATIVE;

ADULT; AGED; ANGIOGRAPHY; CONTRAST MEDIA; CROSS-SECTIONAL STUDIES; EMERGENCY SERVICE, HOSPITAL; FEMALE; HOSPITALS, URBAN; HUMANS; MALE; MIDDLE AGED; PRACTICE PATTERNS, PHYSICIANS'; PULMONARY EMBOLISM; RETROSPECTIVE STUDIES; TERTIARY HEALTHCARE; TOMOGRAPHY, X-RAY COMPUTED; TRIIODOBENZOIC ACIDS;

EID: 84929309549     PISSN: 10703004     EISSN: 14381435     Source Type: Journal    
DOI: 10.1007/s10140-014-1265-6     Document Type: Article

References (48)

1. Smith-Bindman R et al (2012) Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996–2010. JAMA J Am Med Assoc 307:2400–2409
2. Perrier A et al (2005) Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med 352:1760–1768
3. Moores LK, Jackson WL Jr, Shorr AF, Jackson JL (2004) Meta-analysis: Outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography. Ann Intern Med 141:866–874
4. Blachere H et al (2000) Pulmonary embolism revealed on helical CT angiography: Comparison with ventilation-perfusion radionuclide lung scanning. AJR Am J Roentgenol 174:1041–1047
5. Anderson DR et al (2007) Computed tomographic pulmonary angiography vs. ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA J Am Med Assoc 298:2743–2753
6. Stein PD et al (2006) Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 354:2317–2327
7. Schissler AJ et al (2013) CT pulmonary angiography: Increasingly diagnosing less severe pulmonary emboli. PLoS ONE 8:e65669
8. Donohoo JH, Mayo-Smith WW, Pezzullo JA, Egglin TK (2008) Utilization patterns and diagnostic yield of 3421 consecutive multidetector row computed tomography pulmonary angiograms in a busy emergency department. J Comput Assist Tomogr 32:421–425
9. Kuroki M et al (2006) Incidence of pulmonary embolism in younger versus older patients using CT. J Thorac Imaging 21:167–171
10. Groth M et al (2012) Age-related incidence of pulmonary embolism and additional pathologic findings detected by computed tomography pulmonary angiography. Eur J Radiol 81:1913–1916
11. Costa AF, Basseri H, Sheikh A, Stiell I, Dennie C (2013) The yield of CT pulmonary angiograms to exclude acute pulmonary embolism. Emerg Radiol. doi:10.1007/s10140-013-1169-x
12. Sood R, Sood A, Ghosh AK (2007) Non-evidence-based variables affecting physicians’ test-ordering tendencies: a systematic review. Neth J Med 65:167–177
13. Raja AS et al (2012) Effect of computerized clinical decision support on the use and yield of CT pulmonary angiography in the emergency department. Radiology 262:468–474
14. Chandra S, Sarkar PK, Chandra D, Ginsberg NE, Cohen RI (2013) Finding an alternative diagnosis does not justify increased use of CT-pulmonary angiography. BMC Pulm Med 13:9
15. Brown MD, Vance SJ, Kline JA (2005) An emergency department guideline for the diagnosis of pulmonary embolism: an outcome study. Acad Emerg Med Off J Soc Acad Emerg Med 12:20–25
16. Hall WB et al (2009) The prevalence of clinically relevant incidental findings on chest computed tomographic angiograms ordered to diagnose pulmonary embolism. Arch Intern Med 169:1961–1965
17. Adams DM (2013) Adherence to PIOPED II investigators’ recommendations for computed tomography pulmonary angiography. Am J Med 126:36–42
18. Mamlouk MD et al (2010) Pulmonary embolism at CT angiography: Implications for appropriateness, cost, and radiation exposure in 2003 patients. Radiology 256:625–632
19. Richman PB et al (2004) Prevalence and significance of nonthromboembolic findings on chest computed tomography angiography performed to rule out pulmonary embolism: a multicenter study of 1,025 emergency department patients. Acad Emerg Med Off J Soc Acad Emerg Med 11:642–647
20. Lombard J, Bhatia R, Sala E (2003) Spiral computed tomographic pulmonary angiography for investigating suspected pulmonary embolism: Clinical outcomes. Can Assoc Radiol J Assoc Can Radiol 54:147–151
21. Prologo JD, Gilkeson RC, Diaz M, Asaad J (2004) CT pulmonary angiography: a comparative analysis of the utilization patterns in emergency department and hospitalized patients between 1998 and 2003. AJR Am J Roentgenol 183:1093–1096
22. Parker MS et al (2005) Female breast radiation exposure during CT pulmonary angiography. AJR Am J Roentgenol 185:1228–1233
23. Hurwitz LM et al (2007) Radiation dose from contemporary cardiothoracic multidetector CT protocols with an anthropomorphic female phantom: Implications for cancer induction. Radiology 245:742–750
24. Pijpe A et al (2012) Exposure to diagnostic radiation and risk of breast cancer among carriers of BRCA1/2 mutations: Retrospective cohort study (GENE-RAD-RISK). BMJ 345:e5660
25. Larson DB, Johnson LW, Schnell BM, Salisbury SR, Forman HP (2011) National trends in CT use in the emergency department: 1995–2007. Radiology 258:164–173
26. Wiener RS, Schwartz LM, Woloshin S (2011) Time trends in pulmonary embolism in the United States: Evidence of overdiagnosis. Arch Intern Med 171:831–837
27. Rosen MP, Davis RB, Lesky LG (1997) Utilization of outpatient diagnostic imaging. Does the physician’s gender play a role? J Gen Intern Med 12:407–411
28. Lautenschlager NT, Förstl H (2007) Personality change in old age. Curr Opin Psychiatry 20:62–66
29. Schertler T et al (2009) Triple rule-out CT in patients with suspicion of acute pulmonary embolism: Findings and accuracy. Acad Radiol 16:708–717
30. Tsai K-L, Gupta E, Haramati LB (2004) Pulmonary atelectasis: a frequent alternative diagnosis in patients undergoing CT-PA for suspected pulmonary embolism. Emerg Radiol 10:282–286
31. Wells PS et al (2001) Excluding pulmonary embolism at the bedside without diagnostic imaging: Management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med 135:98–107
32. Stiell IG et al (1997) Variation in ED use of computed tomography for patients with minor head injury. Ann Emerg Med 30:14–22
33. Prevedello LM et al (2012) Variation in use of head computed tomography by emergency physicians. Am J Med 125:356–364
34. Mehrotra A et al (2012) Physicians with the least experience have higher cost profiles than do physicians with the most experience. Health Aff Proj Hope 31:2453–2463
35. Charlson ME, Karnik J, Wong M, McCulloch CE, Hollenberg JP (2005) Does experience matter? A comparison of the practice of attendings and residents. J Gen Intern Med 20:497–503
36. Maserejian NN et al (2014) Variations among primary care physicians in exercise advice, imaging, and analgesics for musculoskeletal pain: Results from a factorial experiment. Arthritis Care Res 66:147–156
37. Scholer SJ, Pituch K, Orr DP, Clark D, Dittus RS (1996) Effect of health care system factors on test ordering. Arch Pediatr Adolesc Med 150:1154–1159
38. Ferrier BM, Woodward CA, Cohen M, Williams AP (1996) Clinical practice guidelines. New-to-practice family physicians’ attitudes. Can Fam Physician Médecin Fam Can 42:463–468
39. Moore K, Lucky CA (1999) Emergency medicine training in Canada. CJEM 1:51–53
40. Ducharme J, Innes G (1997) The FRCPC vs. the CCFP(EM): is there a difference 10 years after residency? CAEP Commun Fall 1–4
41. Schattner A (2012) Test appropriateness index. Am J Med 125:e13
42. Kassirer JP (1989) Our stubborn quest for diagnostic certainty. A cause of excessive testing. N Engl J Med 320:1489–1491
43. Lucassen W et al (2011) Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med 155:448–460
44. Rodger MA, Maser E, Stiell I, Howley HEA, Wells PS (2005) The interobserver reliability of pretest probability assessment in patients with suspected pulmonary embolism. Thromb Res 116:101–107
45. Chunilal SD, Eikelboom JW, Attia J et al (2003) Does this patient have pulmonary embolism? JAMA 290:2849–2858
46. Garg K, Sieler H, Welsh CH, Johnston RJ, Russ PD (1999) Clinical validity of helical CT being interpreted as negative for pulmonary embolism: Implications for patient treatment. AJR Am J Roentgenol 172:1627–1631
47. Donato AA, Scheirer JJ, Atwell MS, Gramp J, Duszak R Jr (2003) Clinical outcomes in patients with suspected acute pulmonary embolism and negative helical computed tomographic results in whom anticoagulation was withheld. Arch Intern Med 163:2033–2038
48. Swensen SJ et al (2002) Outcomes after withholding anticoagulation from patients with suspected acute pulmonary embolism and negative computed tomographic findings: a cohort study. Mayo Clin Proc 77:130–138