Osman Mohammed, Subedi Suresh Kumar, Ahmed Azza, Khan Jahangir, Dawood Thair, Ríos-Bedoya Carlos F, Bachuwa Ghassan
Department of Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA.
J Community Hosp Intern Med Perspect. 2018 Feb 6;8(1):6-10. doi: 10.1080/20009666.2018.1428024. eCollection 2018.
: Pulmonary embolism (PE) is a common disease in the USA responsible for up to 10% of hospital mortality. Modified wells score (MWS) and D-dimer assay are used to categorize patients into high or low probability of PE. Patient with high probability need Computed tomography pulmonary angiography (CTPA), while patients with low probability and low D-dimer can safely forgo the CTPA. The aim of this study was to investigate the rate of inappropriate CTPA use in the emergency department of a community teaching hospital. : A retrospective chart review of adult patients who underwent CTPA for suspected PE in the emergency department for 2015 was done. CTPA use was considered inappropriate if MWS was less than or equal to 4 and D-dimer was either not ordered or its value was less than 500 μg/L. Bivariate analysis with Fisher's exact tests and Student's t-tests as well as multivariate logistic regression analysis were done to examine relationship between study explanatory variables and study outcome. : 295 patients were included in the study. The mean age was 51.2(±14.5) years, 68.8% were females. The prevalence of PE was 5.4% and 41% of the CTPAs -were inappropriately ordered. Males were twice (OR 2.1; 95% CI 1.2, 3.6) as likely as females to have an inappropriately ordered CTPA after controlling for a high MWS, age, and tobacco history. : CTPA is overused to diagnose PE in the emergency department. Quality improvement projects are needed to encourage physicians to adhere to the current guidelines.
肺栓塞（PE）在美国是一种常见疾病，导致高达10%的医院死亡率。改良Wells评分（MWS）和D-二聚体检测用于将患者分为PE高概率或低概率。高概率患者需要进行计算机断层扫描肺动脉造影（CTPA），而低概率且D-二聚体低的患者可以安全地不进行CTPA。本研究的目的是调查社区教学医院急诊科CTPA使用不当的发生率。：对2015年在急诊科因疑似PE接受CTPA检查的成年患者进行回顾性病历审查。如果MWS小于或等于4且未检测D-二聚体或其值小于500μg/L，则认为CTPA使用不当。采用Fisher精确检验和Student t检验进行双变量分析以及多变量逻辑回归分析，以检验研究解释变量与研究结果之间的关系。：295名患者纳入研究。平均年龄为51.2（±14.5）岁，68.8%为女性。PE患病率为5.4%，41%的CTPA检查医嘱不当。在控制高MWS、年龄和吸烟史后，男性接受不当CTPA检查医嘱的可能性是女性的两倍（OR 2.1；95%CI 1.2，3.6）。：在急诊科，CTPA被过度用于诊断PE。需要开展质量改进项目，以鼓励医生遵守现行指南。
