Yingming Amy Chen MD, Presenter: Nothing to Disclose

Bruce G. Gray MD, Abstract Co-Author: Nothing to Disclose

Glen Bandiera MD, Abstract Co-Author: Nothing to Disclose

David Mackinnon, Abstract Co-Author: Nothing to Disclose

Djeven Parameshvara Deva MBBCh, Abstract Co-Author: Nothing to Disclose

This project examines the utilization and diagnostic yield patterns for CT pulmonary angiography (CTPA) ordered by individual Emergency Physicians (EPs) at an academic tertiary care center. The study is part of the institution’s quality improvement initiative aimed at establishing quantitative parameters for assessing individual EP’s image utilization.

A cross-sectional retrospective study was conducted on 850 consecutive ED patients with suspected pulmonary embolism (PE) who underwent CTPA. Radiology report data was extracted from our institution’s RIS PACS software (syngo Imaging, Siemens) based on a targeted search of all CTPA reports from January 2010 to December 2012. Positivity rate for PE as well as nonthrombotic clinically significant findings were calculated. Utilization rates and positivity rates for individual physicians were calculated and correlated with both years of experience and certification.

Acute PE was diagnosed in 142 of the 850 patients evaluated by CTPA (16.7%). A further 25.2% of scans were negative for PE but had other clinically significant findings: 11.2% infection, 2.7% pulmonary edema, 2.9% effusion, 3.1% tumour, and 4.9% other. EPs ordered an average of 0.5 CTPA scans per 100 patients seen, with a significant variation across EPs in utilization (0.2 to 1 scans per 100 patients). Considerable variation also existed in the positivity rate for PE, ranging between 6.5% and 38.9%. There was no significant correlation between EP years of experience and utilization rate (linear regression r = - 0.27; ANOVA p = 0.36 for <10 years, 10-20 years, >20 years) or positivity rate (r = -0.32; ANOVA p = 0.39). Furthermore, utilization and positivity rates were not significantly different between EPs with emergency medicine certification by the Royal College (FRCP) vs by the College of Family Physicians of Canada (CCFP-EM) (student t-test p = 0.34 for utilization rate, p = 0.56 for positivity rate).

While average utilization and positivity rates of CTPA for ED patients with suspected PE at our institution are comparable to those in the literature, considerable interphysician variability exists for both metrics. Utilization and positivity rates for CTPA did not correlate with either the physicians’ years of experience or specialty certification.

Results of the study suggest an opportunity for a more standardized approach to the of use of CTPA among EPs.

Chen, Y, Gray, B, Bandiera, G, Mackinnon, D, Deva, D, Variation in Utilization and Positivity Rates of CTPA among Emergency Physicians at an Academic Tertiary Emergency Department.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13018809.html