Chest CT for Suspected PE in EDs

Educational Objectives

Summary

Chest CT for Suspected Pulmonary Embolism in Emergency Departments

Despite more use of computed tomographic pulmonary angiography (CTPA) in emergency departments (EDs) to evaluate patients for suspected pulmonary embolism (PE), PE mortality has remained stagnant. One goal of clinical decision rules is to identify patients at low risk who do not need imaging to rule out PE — decision rules include age-adjusted d-dimer (https://www.mdcalc.com/calc/10138/age-adjusted-d-dimer-venous-thromboembolism-vte), PE Rule-Out Criteria (PERC; https://www.mdcalc.com/calc/347/perc-rule-pulmonary-embolism), and YEARS Algorithm for PE (https://www.mdcalc.com/calc/4067/years-algorithm-for-pulmonary-embolism-pe). In a retrospective study in the Annals of Internal Medicine (https://doi.org/10.7326/M22-3116), European investigators assessed nearly 9000 patients who presented with suspected PE to 26 emergency departments in 6 countries and who underwent CTPAs from 2015 to 2019.

In an adjusted analysis, patients in 2019, compared with patients in 2015, had significantly more frequent use of CTPA (1112 vs 836 per 100,000 ED visits), more frequent diagnosis of PE (164 vs 138 per 100,000 ED visits), higher proportions of low-risk PEs (17% vs 9%), and lower proportions of intensive care unit admissions (21% vs 28%).

Despite decision-rule availability, CTPA use per number of patients seen in EDs has increased — raising concerns about unnecessary radiation exposure, adverse reactions, or overdiagnosis of potentially clinically irrelevant PEs (e.g., isolated single subsegmental PEs) — with much of that increase in diagnosis among low-risk patients (https://www.jwatch.org/na54341 and Ann Intern Med 2022; 175:29). Systematic education about, and structured implementation of, decision rules to guide further imaging of patients for PE might help limit CTPA use. One limitation of this study is that some of the decision rules were introduced during the 2015 to 2019 timeframe (e.g., YEARS), whereas others predated 2015.

Daniel D. Dressler, MD, MSc, MHM, FACP

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Acknowledgements

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.00 CE contact hours.

Lecture ID:

JW341321

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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