I’m Clare from Northern Ireland currently working as a General Medicine Registrar in Midcentral DHB since July 2021. Prior to that I worked for 7 months in the Emergency Department upon arriving in New Zealand December 2020.
I graduated from Dundee University in 2018 with MBChB and BSC in Medical Science in Neuropharmacology and Behaviour.
As a doctor I strive to promote the use of clinical guidelines to encourage better use of medical resources and deliver quality patient care.
I chose to live in NZ as I love to travel and greatly enjoy the outdoor life.
Jack Duncan- from Aberdeenshire in Scotland. I studied medicine in Dundee Medical School, with an intercalated degree in Neuropharmacology and Behaviour. I worked for 2 and a half years as a junior doctor in Glasgow before moving to New Zealand in January 2021. I have worked in Palmerston North Hospital medical department for the past year. Outside of work I like to climb hills and mountain bike.
The Evaluation Of Suspected Pulmonary Embolism In MidCentral Emergency Department
Background- There are increasing concerns regarding overutilisation of CTPA. Clinical decision tools such as Wells Score, PERC and D-dimer have been developed for risk stratification to rationalise the use of CTPA in ED for patients with suspected PE.
Aim- To evaluate the use of the clinical decision tools when choosing to perform further imaging to diagnose PE and to validate the clinical probability scores and D-dimer.
Methods- We carried out a retrospective cohort study including 272 patients who presented to Midcentral DHB investigated with a CTPA from September 2020 to March 2021.
Results- 272 CTPA scans examined. Out of 144 low risk patients, 16 were PERC negative. 128 were PERC positive, 54 of which did not have a D-dimer, 26 had a D-dimer <1000. Out of 107 medium risk patients, 48 did not have a D-dimer. 12 had D-dimer less than age adjusted or <500. 19.1% did not have a PERC or Wells score documented.
Discussion- Use of PERC and D-dimer in low-risk patients and application of age adjusted D-dimer in medium risk patients could have avoided 54 CTPA scans. 102 patients should have had a D-dimer before performing a CTPA scan. Only 116 of 272 (42.6%) patients were correctly risk stratified prior to undergoing a CTPA according to our current clinical guidelines.
Conclusion- Adherence to our clinical guidelines will promote better clinical practice and ultimately facilitate the provision of safe patient care.