Dr Jennifer Zhou graduated from Monash University in 2016. She is currently doing her second year of Basic Physician Training at Alfred Health, Melbourne.
Lung Imaging At Medical Emergency Team Calls For Inpatients: LIMIT CTP
Computed tomography pulmonary angiography (CTPA) is the gold standard test for pulmonary embolism (PE), but may be overused. This has not been well studied in the Australian inpatient setting. We aimed to evaluate CTPA use following inpatient medical emergency team (MET) calls for clinical deterioration at an Australian hospital. Specifically, we studied the diagnostic yield and presence of alternative diagnoses.
We performed a retrospective audit of all patients who underwent CTPA for suspected PE within 24 hours of a MET call at The Alfred Hospital, Melbourne between 1 January 2017 and 31 December 2017. Demographic details, clinical history and imaging results were analysed.
155 patients underwent CTPA during the study period. PE was diagnosed in 19 patients (12.3%). 94.7% of detected PEs were segmental or larger. CTPA revealed clinically relevant alternative diagnoses in 91 patients (58.7%), most commonly consolidation (24.5%) or moderate to large pleural effusion (11.0%). These were not visible on initial chest x-ray in 40 cases, and had therapeutic consequences in 19 cases (12.3%). Chest x-ray was used as an initial test in 79.3% of patients. Normal chest x-ray predicted a higher rate of PE on CTPA (22.2% vs 9.2%, p=0.037). Other predictors of PE were recent orthopaedic or spinal surgery.
CTPAs performed at our centre in acutely deteriorating inpatients had a higher yield than predicted, revealing a diagnosis of significant PE or other clinically relevant pathology in 70% of patients. While the use of chest x ray as initial investigation may reduce the need for CTPA in some individuals, this retrospective study has demonstrated that the current use of CTPAs in this population in our centre impacted positively on their inpatient progression of care.