Ordering CT pulmonary angiography to exclude pulmonary embolism: defense versus evidence in the emergency room
| Autor: | Janet Buatsi, Heinz Zimmermann, Martin Rohacek, Zsolt Szucs-Farkas, C. Stoupis, Birgit Kleim, Aristomenis K. Exadaktylos |
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| Přispěvatelé: | University of Zurich, Rohacek, Martin |
| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Defensive Medicine
Male medicine.medical_specialty Computed tomography Pulmonary Artery Critical Care and Intensive Care Medicine Defensive medicine Fibrin Fibrinogen Degradation Products Anesthesiology Surveys and Questionnaires Pulmonary angiography Medicine Humans Diagnostic Errors Practice Patterns Physicians' Ct pulmonary angiography medicine.diagnostic_test 10093 Institute of Psychology business.industry Middle Aged medicine.disease Pulmonary embolism Female Radiology 150 Psychology 2706 Critical Care and Intensive Care Medicine business Emergency Service Hospital Pulmonary Embolism Tomography X-Ray Computed |
| Zdroj: | Rohacek, Martin; Buatsi, Janet; Szucs-Farkas, Zsolt; Kleim, Birgit; Zimmermann, Heinz; Exadaktylos, Aristomenis; Stoupis, Christoforos (2012). Ordering CT pulmonary angiography to exclude pulmonary embolism: defense versus evidence in the emergency room. Intensive care medicine, 38(8), pp. 1345-51. Berlin: Springer-Verlag 10.1007/s00134-012-2595-z |
| DOI: | 10.7892/boris.13525 |
| Popis: | Purpose: To identify reasons for ordering computed tomography pulmonary angiography (CTPA), to identify the frequency of reasons for CTPA reflecting defensive behavior and evidence-based behavior, and to identify the impact of defensive medicine and of training about diagnosing pulmonary embolism (PE) on positive results of CTPA. Methods: Physicians in the emergency department of a tertiary care hospital completed a questionnaire before CTPA after being trained about diagnosing PE and completing questionnaires. Results: Nine hundred patients received a CTPA during 3years. For 328 CTPAs performed during the 1-year study period, 140 (43%) questionnaires were completed. The most frequent reasons for ordering a CTPA were to confirm/rule out PE (93%), elevated D-dimers (66%), fear of missing PE (55%), and Wells/simplified revised Geneva score (53%). A positive answer for "fear of missing PE” was inversely associated with positive CTPA (OR 0.36, 95% CI 0.14-0.92, p=0.033), and "Wells/simplified revised Geneva score” was associated with positive CTPA (OR 3.28, 95% CI 1.24-8.68, p=0.017). The proportion of positive CTPA was higher if a questionnaire was completed, compared to the 2-year comparison period (26.4 vs. 14.5%, OR 2.12, 95% CI 1.36-3.29, p |
| Databáze: | OpenAIRE |
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