CT Pulmonary Embolism

CT for Suspected Pulmonary Embolism

Evidence supports that CT scans to evaluate for blood clots in the lung, a condition called pulmonary embolism, are increasingly being over-utilized and leading to many of these studies being negative when conducted.  In contrast, there are many evidence-based tools and risk calculators to guide medical decision-making to help stratify patients and better tailor an approach to evaluating for this diagnosis prior to obtaining a CT.  Sometimes, but not always, this strategy may call for the use of a blood test called a D-dimer.  As these types of CT scans expose patients to ionizing radiation and the use of a dye in the veins during the test that can cause kidney injury, it is important that this test be used for only patients at elevated risk for the disease.  This approach has been endorsed as a Choosing Wisely recommendation by the American College of Emergency Physicians.  Within the Michigan Emergency Department Improvement Collaborative, we measure clinical performance by reporting the percentage of CT scans ordered for suspected pulmonary embolism that are positive for pulmonary embolism, also called diagnostic yield.

 

Emergency Evaluation for Pulmonary Embolism, Part 1: Clinical Factors That Increase Risk

Emergency Evaluation for Pulmonary Embolism, Part 2: Diagnostic Approach

Prospective Multicenter Evaluation of the Pulmonary Embolism Rule-Out Criteria

Criticial Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Pulmonary Embolism