caa a22 4500 606171746 CHVBK 20210128100724.0 cr unu---uuuuu 210128e20150801xx s 000 0 eng 10.1007/s10140-014-1290-5 doi (NATIONALLICENCE)springer-10.1007/s10140-014-1290-5 MDCT diagnosis of acute pulmonary embolism in the emergent setting [Elektronische Daten] [Nainesh Parikh, Elizabeth Morris, James Babb, Maj Wickstrom, John McMenamy, Rahul Sharma, David Schwartz, Mark Lifshitz, Danny Kim] To compare utilization of CT pulmonary angiogram (CTA) for diagnosis of pulmonary embolism (PE) in an emergency department (ED) with unstructured CT ordering to published rates of CT positivity in other EDs including those employing decision support and to identify pathways for improved utilization via collaboration with our pathology and ED colleagues. Two hundred seventeen patients over a 2.5-month time period who received a CTA for PE were reviewed with exclusion of pediatric patients and all sub-optimal, non-diagnostic, or equivocal scans; 21 were excluded leaving a sample of 196 patients. The rate of PE diagnosis and association of PE positivity with selected factors (D-dimer testing) was assessed. The percentage of cases positive for PE was 10.7% (21/196) which is similar to the frequently published rate of 10% in other emergency departments including settings that have studied the use of decision support. D-dimer testing was performed in 40.3% of cases. In 29.6% (58/196) of subjects, D-dimer was positive, 10.7% (21/196) was negative, and 59.7% (117/196) was not assessed. Prevalence of PE among D-dimer negative (0%, 0/21) was lower versus positive D-dimer (12.1%, 7/58) and unknown D-dimer patients (12.0%, 14/117). D-dimer had 100% (21/21) negative predictive value for the diagnosis of PE. While this suggests that D-dimer is useful to rule-out PE, due to the small number of patients with PE, the 95% confidence intervals are wide and the post-test likelihood of PE could be as high as 14%. The rate of CT positivity for PE in an ED with unstructured CT ordering is similar to that in other published series including as series in which decision support was used. While D-dimer had high negative predictive value, large studies are needed to confirm this high sensitivity and potentially increase its use in ruling out PE without CT and to reduce CT ordering particularly in patients with sufficiently low clinical pre-test probability of PE. American Society of Emergency Radiology, 2015 Cost-effectiveness nationallicence Quality nationallicence Pulmonary embolism nationallicence D-dimer nationallicence CT pulmonary nationallicence Angiogram nationallicence Parikh Nainesh Department of Radiology, NYU Langone Medical Center, 660 1st Avenue, 3rd Floor, 10016, New York, NY, USA aut Morris Elizabeth Department of Radiology, NYU Langone Medical Center, 660 1st Avenue, 3rd Floor, 10016, New York, NY, USA aut Babb James Department of Radiology, NYU Langone Medical Center, 660 1st Avenue, 3rd Floor, 10016, New York, NY, USA aut Wickstrom Maj Department of Radiology, NYU Langone Medical Center, 660 1st Avenue, 3rd Floor, 10016, New York, NY, USA aut McMenamy John Department of Radiology, NYU Langone Medical Center, 660 1st Avenue, 3rd Floor, 10016, New York, NY, USA aut Sharma Rahul Department of Emergency, NYU Langone Medical Center, 560 1st Avenue, 10016, New York, NY, USA aut Schwartz David Department of Emergency, NYU Langone Medical Center, 560 1st Avenue, 10016, New York, NY, USA aut Lifshitz Mark Department of Pathology, NYU Langone Medical Center, 550 1st Avenue, 10016, New York, NY, USA aut Kim Danny Department of Radiology, NYU Langone Medical Center, 660 1st Avenue, 3rd Floor, 10016, New York, NY, USA aut Emergency Radiology Springer Berlin Heidelberg 22/4(2015-08-01), 379-384 1070-3004 22:4<379 2015 22 10140 https://doi.org/10.1007/s10140-014-1290-5 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10140-014-1290-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Parikh Nainesh Department of Radiology, NYU Langone Medical Center, 660 1st Avenue, 3rd Floor, 10016, New York, NY, USA aut NATIONALLICENCE 700 1- Morris Elizabeth Department of Radiology, NYU Langone Medical Center, 660 1st Avenue, 3rd Floor, 10016, New York, NY, USA aut NATIONALLICENCE 700 1- Babb James Department of Radiology, NYU Langone Medical Center, 660 1st Avenue, 3rd Floor, 10016, New York, NY, USA aut NATIONALLICENCE 700 1- Wickstrom Maj Department of Radiology, NYU Langone Medical Center, 660 1st Avenue, 3rd Floor, 10016, New York, NY, USA aut NATIONALLICENCE 700 1- McMenamy John Department of Radiology, NYU Langone Medical Center, 660 1st Avenue, 3rd Floor, 10016, New York, NY, USA aut NATIONALLICENCE 700 1- Sharma Rahul Department of Emergency, NYU Langone Medical Center, 560 1st Avenue, 10016, New York, NY, USA aut NATIONALLICENCE 700 1- Schwartz David Department of Emergency, NYU Langone Medical Center, 560 1st Avenue, 10016, New York, NY, USA aut NATIONALLICENCE 700 1- Lifshitz Mark Department of Pathology, NYU Langone Medical Center, 550 1st Avenue, 10016, New York, NY, USA aut NATIONALLICENCE 700 1- Kim Danny Department of Radiology, NYU Langone Medical Center, 660 1st Avenue, 3rd Floor, 10016, New York, NY, USA aut NATIONALLICENCE 773 0- Emergency Radiology Springer Berlin Heidelberg 22/4(2015-08-01), 379-384 1070-3004 22:4<379 2015 22 10140