Serial use of existing clinical decisions aids can reduce computed tomography pulmonary angiography for pulmonary embolism

Ehrman, Robert R.; Malik, Adrienne; Smith, Reid Kenneth; Kalarikkal, Zeid; Huang, Aihua; King, Ryan Michael; Green, Rubin David; O’Neil, Brian J.; Sherwin, Robert

doi:10.1007/s11739-021-02703-1

Cited by 2 publications

(1 citation statement)

References 35 publications

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“…Thus, the use of clinical decision aids and blood tests may help reduce the resource and economic burdens on our health system. 4 The high negative predictive value of D-dimer assays has been most useful for excluding the diagnosis of PE [4][5][6] , particularly for patients in the Emergency Department (ED) 7,8 . However, many did not undergo imaging investigations and this needs to be taken into account.…”

Section: Introductionmentioning

confidence: 99%

D-dimer level has higher correlation with pulmonary embolism diagnosis than a clinical prediction score

Alipour²,

Mitric

et al. 2021

Preprint

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Aim This study aimed to compare the predictive value of D-dimer and a clinical prediction score in diagnosis of pulmonary embolism (PE) as this could improve practice and reduce costs simultaneously. Method To achieve this, medical records of patients who presented to the Emergency Department of a large Australian metropolitan general hospital over 12 months and underwent DD testing were reviewed. The correlation coefficient (CC) was calculated using the Cramer’s V method. Results CC between low-, intermediate- and high-risk groups on their own and a final diagnosis of PE on imaging was 0.1332, 0.1278 and 0.0817, respectively. By contrast, the CC when using positive DD was higher for all categories: 0.7527, 0.6256 and 0.4195, respectively. For the age-adjusted DD, the correlations were higher than for the clinical prediction score but less than for the absolute DD; calculated at 0.6490, 0.4987 and 0.3550 for the respective groups. The overall CC for risk category was 0.1107; for a positive DD, it was 0.7033; for the age-adjusted DD, it was 0.5928. Conclusion Positive DD has a higher correlation with PE diagnosis than the clinical prediction score. DD assay, whether positive or negative, is therefore an invaluable test in assessment of patients with suspected PE and can help determine the need for tomographic imaging. The absolute DD is more useful than the age-adjusted value.

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Section: Introductionmentioning

confidence: 99%

D-dimer level has higher correlation with pulmonary embolism diagnosis than a clinical prediction score

Alipour²,

Mitric

et al. 2021

Preprint

View full text Add to dashboard Cite

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Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Kjelle

Andersen

Soril

et al. 2021

BMC Health Serv Res

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Background It is estimated that 20–50% of all radiological examinations are of low value. Many attempts have been made to reduce the use of low-value imaging. However, the comparative effectiveness of interventions to reduce low-value imaging is unclear. Thus, the objective of this systematic review was to provide an overview and evaluate the outcomes of interventions aimed at reducing low-value imaging. Methods An electronic database search was completed in Medline – Ovid, Embase-Ovid, Scopus, and Cochrane Library for citations between 2010 and 2020. The search was built from medical subject headings for Diagnostic imaging/Radiology, Health service misuse or medical overuse, and Health planning. Keywords were used for the concept of reduction and avoidance. Reference lists of included articles were also hand-searched for relevant citations. Only articles written in English, German, Danish, Norwegian, Dutch, and Swedish were included. The Mixed Methods Appraisal Tool was used to appraise the quality of the included articles. A narrative synthesis of the final included articles was completed. Results The search identified 15,659 records. After abstract and full-text screening, 95 studies of varying quality were included in the final analysis, containing 45 studies found through hand-searching techniques. Both controlled and uncontrolled before-and-after studies, time series, chart reviews, and cohort studies were included. Most interventions were aimed at referring physicians. Clinical practice guidelines (n = 28) and education (n = 28) were most commonly evaluated interventions, either alone or in combination with other components. Multi-component interventions were often more effective than single-component interventions showing a reduction in the use of low-value imaging in 94 and 74% of the studies, respectively. The most addressed types of imaging were musculoskeletal (n = 26), neurological (n = 23) and vascular (n = 16) imaging. Seventy-seven studies reported reduced low-value imaging, while 3 studies reported an increase. Conclusions Multi-component interventions that include education were often more effective than single-component interventions. The contextual and cultural factors in the health care systems seem to be vital for successful reduction of low-value imaging. Further research should focus on assessing the impact of the context in interventions reducing low-value imaging and how interventions can be adapted to different contexts.

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Serial use of existing clinical decisions aids can reduce computed tomography pulmonary angiography for pulmonary embolism

Cited by 2 publications

References 35 publications

D-dimer level has higher correlation with pulmonary embolism diagnosis than a clinical prediction score

D-dimer level has higher correlation with pulmonary embolism diagnosis than a clinical prediction score

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

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