Decision Support Tools Help Optimize Acute PE Detection

Clinical decision support improves efficacy of CT screening for acute pulmonary embolism

WEDNESDAY, Feb. 1 (HealthDay News) -- Implementing evidence-based clinical decision support (CDS) significantly improves the efficiency of computed tomographic (CT) angiography use to detect acute pulmonary embolism (PE) for patients presenting to an emergency department, according to a study published in the February issue of Radiology.

Ali S. Raja, M.D., M.B.A., M.P.H., of Brigham and Women's Hospital in Boston, and associates analyzed 338,230 patients who presented to the emergency department from Oct. 1, 2003, to Sept. 30, 2009, to investigate the effect of computerized CDS on use patterns and variations of yield (testing positive for acute PE) in CT pulmonary angiography exams.

The researchers found that 6,838 patients (2.0 percent) underwent CT testing, with 686 (10 percent) yielding positive for acute PE during the six-year study period. Data showed quarterly CT pulmonary angiography use increased significantly from 14.5 to 26.4 examinations per 1,000 patients (P < 0.0001) before CDS implementation, between Oct. 10, 2003, and July 31, 2007. It then declined from Aug. 1, 2007, to Sept. 30, 2009, to 21.1 quarterly examinations per 1,000 patients (P = 0.0379). Subsequent to CDS implementation, the yield by quarter improved from 5.8 to 9.8 percent (69.0 percent overall; P = 0.0323).

"Implementation of evidence-based CDS in the emergency department was associated with a significant decrease in use, and increase in yield, of CT pulmonary angiography for the evaluation of acute PE," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry as well as Medicalis and Diagnotion, which have developed clinical decision support tools.

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