Roussel M, Bloom B, Taalba M, Choquet C, Douillet D, Fémy F, Marouk A, Gorlicki J, Gerlier C, Macrez R, Arnaud E, Bompard R, Montassier E, Hugli O, Czopik C, Eyer X, Benhamed A, Peyrony O, Chouihed T, Penaloza A, Marra A, Laribi S, Reuter PG, Behringer W, Douplat M, Guenezan J, Javaud N, Lucidarme O, Cachanado M, Aparicio-Monforte A, Freund Y; Improving Emergency Care (IMPEC) FHU Collaborator Group
Ann Intern Med. 2023 May 23. doi: 10.7326/M22-3116
Background: Recently, validated clinical decision rules have been developed that avoid unnecessary use of computed tomographic pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) in the emergency department (ED).
Objective: To measure any resulting change in CTPA use for suspected PE.
Design: Retrospective analysis.
Setting: 26 European EDs in 6 countries.
Patients: Patients with CTPA performed for suspected PE in the ED during the first 7 days of each odd month between January 2015 and December 2019.
Measurements: The primary end points were the CTPAs done for suspected PE in the ED and the number of PEs diagnosed in the ED each year adjusted to an annual census of 100 000 ED visits. Temporal trends were estimated using generalized linear mixed regression models.
Results: 8970 CTPAs were included (median age, 63 years; 56% female). Statistically significant temporal trends for more frequent use of CTPA (836 per 100 000 ED visits in 2015 vs. 1112 in 2019; P < 0.001), more diagnosed PEs (138 per 100 000 in 2015 vs. 164 in 2019; P = 0.028), a higher proportion of low-risk PEs (annual percent change [APC], 13.8% [95% CI, 2.6% to 30.1%]) with more ambulatory management (APC, 19.3% [CI, 4.1% to 45.1%]), and a lower proportion of intensive care unit admissions (APC, -8.9% [CI, -17.1% to -0.3%]) were observed.
Limitation: Data were limited to 7 days every 2 months.
Conclusion: Despite the recent validation of clinical decision rules to limit the use of CTPA, an increase in the CTPA rate along with more diagnosed PEs and especially low-risk PEs were instead observed.