A United Kingdom based survey of clinical practice in the diagnosis of suspected pulmonary embolism.

OBJECTIVE

To identify UK practice in the diagnosis of suspected pulmonary embolism with particular reference to the pregnant population and to determine whether the 2003 British Thoracic Society (BTS) guidelines had influenced practice.

METHOD

A postal survey was performed of all 249 nuclear medicine departments in the UK identified from the British Nuclear Medicine Society database.

RESULTS

One hundred and one responses were received (41%). Ninety-eight centres (97%) performed scintigraphy with 17 using perfusion only imaging. A median of six (range: 1-27) scintigraphic scans were performed weekly. Ninety-seven centres had computed tomography (CT) capabilities although 11 centres only had single slice CT capability. A median of seven (range: 1-50) CT pulmonary angiographies (CTPAs) were performed weekly. Seventy-two centres used a diagnostic algorithm; 73 centres performed D-dimers routinely and 86 used probability criteria for reporting ventilation/perfusion (V/Q) scans. CTPA was performed in the majority of the cases with an abnormal chest radiograph. In pregnancy, 37 centres routinely performed D-dimers, 80 centres performed a scintigraphic based investigation as a first line test while 12 preferred CTPA. Of the 33 centres (34%) that indicated that the BTS guidelines had changed their practice, 30 (91%) commented that the demand for CTPA had increased and 29 (88%) felt that the service had been improved.

CONCLUSION

There continues to be widely varying practice throughout the UK despite the BTS guidelines. There is a shift in practice towards CTPA and variation in the approach to diagnosis in pregnancy. The survey highlights the need to standardize the diagnostic algorithm for suspected pulmonary embolism, especially in pregnancy.