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dc.contributor.authorMountain, David
dc.contributor.authorKeijzers, Gerben
dc.contributor.authorChu, Kevin
dc.contributor.authorJoseph, Anthony
dc.contributor.authorRead, Catherine
dc.contributor.authorBlecher, Gabriel
dc.contributor.authorFuryk, Jeremy
dc.contributor.authorBharat, Chrianna
dc.contributor.authorVelusamy, Karthik
dc.contributor.authorMunro, Andrew
dc.contributor.authorBaker, Kylie
dc.contributor.authorKinnear, Frances
dc.contributor.authorMukherjee, Ahses
dc.contributor.authorWatkins, Gina
dc.contributor.authoret al.
dc.date.accessioned2021-10-28T04:10:00Z
dc.date.available2021-10-28T04:10:00Z
dc.date.issued2016
dc.identifier.issn1932-6203en_US
dc.identifier.doi10.1371/journal.pone.0166483en_US
dc.identifier.urihttp://hdl.handle.net/10072/409517
dc.description.abstractIntroduction: Overuse of CT Pulmonary Angiograms (CTPA) for diagnosing pulmonary embolism (PE), particularly in Emergency Departments (ED), is considered problematic. Marked variations in positive CTPA rates are reported, with American 4-10% yields driving most concerns. Higher resolution CTPA may increase sub-segmental PE (SSPE) diagnoses, which may be up to 40% false positive. Excessive use and false positives could increase harm vs. benefit. These issues have not been systematically examined outside America. Aims: To describe current yield variation and CTPA utilisation in Australasian ED, exploring potential factors correlated with variation. Methods: A retrospective multi-centre review of consecutive ED-ordered CTPA using standard radiology reports. ED CTPA report data were inputted onto preformatted data-sheets. The primary outcome was site level yield, analysed both intra-site and against a nominated 15.3% yield. Factors potentially associated with yield were assessed for correlation. Results: Fourteen radiology departments (15 ED) provided 7077 CTPA data (94% ≥64-slice CT); PE were reported in 1028 (yield 14.6% (95%CI 13.8-15.4%; range 9.3-25.3%; site variation p <0.0001) with four sites significantly below and one above the 15.3% target. Admissions, CTPA usage, PE diagnosis rates and size of PE were uncorrelated with yield. Large PE (≥lobar) were 55% (CI: 52.1-58.2%) and SSPE 8.8% (CI: 7.1-10.5%) of positive scans. CTPA usage (0.2-1.5% adult attendances) was correlated (p<0.006) with PE diagnosis but not SSPE: large PE proportions. Discussion/ Conclusions: We found significant intra-site CTPA yield variation within Australasia. Yield was not clearly correlated with CTPA usage or increased small PE rates. Both SSPE and large PE rates were similar to higher yield historical cohorts. CTPA use was considerably below USA 2.5-3% rates. Higher CTPA utilisation was positively correlated with PE diagnoses, but without evidence of increased proportions of small PE. This suggests that increased diagnoses seem to be of clinically relevant sized PE.en_US
dc.description.peerreviewedYesen_US
dc.languageEnglishen_US
dc.publisherPUBLIC LIBRARY SCIENCEen_US
dc.relation.ispartofjournalPLOS ONEen_US
dc.relation.ispartofvolume11en_US
dc.subject.keywordsScience & Technologyen_US
dc.subject.keywordsMultidisciplinary Sciencesen_US
dc.subject.keywordsScience & Technology - Other Topicsen_US
dc.subject.keywordsCT Angiographyen_US
dc.subject.keywordsRuleen_US
dc.titleRESPECT-ED: Rates of Pulmonary Emboli ( PE) and Sub-Segmental PE with Modern Computed Tomographic Pulmonary Angiograms in Emergency Departments: A Multi-Center Observational Study Finds Significant Yield Variation, Uncorrelated with Use or Small PE Ratesen_US
dc.typeJournal articleen_US
dc.type.descriptionC1 - Articlesen_US
dcterms.bibliographicCitationMountain, D; Keijzers, G; Chu, K; Joseph, A; Read, C; Blecher, G; Furyk, J; Bharat, C; Velusamy, K; Munro, A; Baker, K; Kinnear, F; Mukherjee, A; Watkins, G; Buntine, P; Livesay, G; Fatovich, D, RESPECT-ED: Rates of Pulmonary Emboli ( PE) and Sub-Segmental PE with Modern Computed Tomographic Pulmonary Angiograms in Emergency Departments: A Multi-Center Observational Study Finds Significant Yield Variation, Uncorrelated with Use or Small PE Rates, PLOS ONE, 2016, 11en_US
dcterms.dateAccepted2016-10-28
dc.date.updated2021-10-28T04:07:38Z
gro.hasfulltextNo Full Text
gro.griffith.authorKeijzers, Gerben


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