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Long-Term Experience With a Mandatory Clinical Decision Rule and Mandatory d-Dimer in the Evaluation of Suspected Pulmonary Embolism.
J Am Coll Radiol. 2018 Dec; 15(12):1673-1680.JA

Abstract

PURPOSE

This study evaluated the long-term effectiveness of mandatory assignment of both a clinical decision rule (CDR) and highly sensitive d-dimer in the evaluation of patients with suspected pulmonary embolism (PE).

MATERIALS AND METHODS

Institutional guidelines with a CDR and highly sensitive d-dimer were embedded in an order entry menu with mandatory assignment of key components before ordering a CT pulmonary angiogram (CTPA). Data were retrospectively extracted from the electronic health record.

RESULTS

This was a retrospective review of 1,003 CTPA studies (905 patients, 845 male and 60 female patients, age 63.7 ± 13.5 years). CTPAs were positive for PE in 170 studies (17%), representing an average yield of 15% (year [average]; 2007 [15%], 2008 [18%], 2009 [15%], 2010 [15%], 2011 [17%], 2012 [15%], 2013 [23%]). The increased yield represented efforts of mandatory order entry assignments, educational sessions, and clinical champions. Different d-dimer thresholds with or without age adjustments in combination with the CDR identified about 10% of patients who may have been managed without CTPA.

CONCLUSION

Mandatory assignment of a CDR and highly sensitive d-dimer clinical decision pathway can be successfully incorporated into an order entry menu and produce a sustained increase in CTPA yield of patients with suspected PE.

Authors+Show Affiliations

Pulmonary and Critical Care, Internal Medicine, and Radiology, West Los Angeles VA Healthcare Center, Los Angeles, California. Electronic address: guy.soohoo@va.gov.Department of Radiology, Stanford University School of Medicine, Stanford, California.Pulmonary and Critical Care, Internal Medicine, and Radiology, West Los Angeles VA Healthcare Center, Los Angeles, California.Pulmonary and Critical Care, Internal Medicine, and Radiology, West Los Angeles VA Healthcare Center, Los Angeles, California.Pulmonary and Critical Care, Internal Medicine, and Radiology, West Los Angeles VA Healthcare Center, Los Angeles, California.Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29907418

Citation

Soo Hoo, Guy W., et al. "Long-Term Experience With a Mandatory Clinical Decision Rule and Mandatory d-Dimer in the Evaluation of Suspected Pulmonary Embolism." Journal of the American College of Radiology : JACR, vol. 15, no. 12, 2018, pp. 1673-1680.
Soo Hoo GW, Tsai E, Vazirani S, et al. Long-Term Experience With a Mandatory Clinical Decision Rule and Mandatory d-Dimer in the Evaluation of Suspected Pulmonary Embolism. J Am Coll Radiol. 2018;15(12):1673-1680.
Soo Hoo, G. W., Tsai, E., Vazirani, S., Li, Z., Barack, B. M., & Wu, C. C. (2018). Long-Term Experience With a Mandatory Clinical Decision Rule and Mandatory d-Dimer in the Evaluation of Suspected Pulmonary Embolism. Journal of the American College of Radiology : JACR, 15(12), 1673-1680. https://doi.org/10.1016/j.jacr.2018.04.031
Soo Hoo GW, et al. Long-Term Experience With a Mandatory Clinical Decision Rule and Mandatory d-Dimer in the Evaluation of Suspected Pulmonary Embolism. J Am Coll Radiol. 2018;15(12):1673-1680. PubMed PMID: 29907418.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-Term Experience With a Mandatory Clinical Decision Rule and Mandatory d-Dimer in the Evaluation of Suspected Pulmonary Embolism. AU - Soo Hoo,Guy W, AU - Tsai,Emily, AU - Vazirani,Sondra, AU - Li,Zhaoping, AU - Barack,Bruce M, AU - Wu,Carol C, Y1 - 2018/06/12/ PY - 2018/02/03/received PY - 2018/04/13/revised PY - 2018/04/30/accepted PY - 2018/6/17/pubmed PY - 2019/4/13/medline PY - 2018/6/17/entrez KW - CT pulmonary angiography KW - Clinical decision rule KW - pulmonary embolism SP - 1673 EP - 1680 JF - Journal of the American College of Radiology : JACR JO - J Am Coll Radiol VL - 15 IS - 12 N2 - PURPOSE: This study evaluated the long-term effectiveness of mandatory assignment of both a clinical decision rule (CDR) and highly sensitive d-dimer in the evaluation of patients with suspected pulmonary embolism (PE). MATERIALS AND METHODS: Institutional guidelines with a CDR and highly sensitive d-dimer were embedded in an order entry menu with mandatory assignment of key components before ordering a CT pulmonary angiogram (CTPA). Data were retrospectively extracted from the electronic health record. RESULTS: This was a retrospective review of 1,003 CTPA studies (905 patients, 845 male and 60 female patients, age 63.7 ± 13.5 years). CTPAs were positive for PE in 170 studies (17%), representing an average yield of 15% (year [average]; 2007 [15%], 2008 [18%], 2009 [15%], 2010 [15%], 2011 [17%], 2012 [15%], 2013 [23%]). The increased yield represented efforts of mandatory order entry assignments, educational sessions, and clinical champions. Different d-dimer thresholds with or without age adjustments in combination with the CDR identified about 10% of patients who may have been managed without CTPA. CONCLUSION: Mandatory assignment of a CDR and highly sensitive d-dimer clinical decision pathway can be successfully incorporated into an order entry menu and produce a sustained increase in CTPA yield of patients with suspected PE. SN - 1558-349X UR - https://www.unboundmedicine.com/medline/citation/29907418/Long_Term_Experience_With_a_Mandatory_Clinical_Decision_Rule_and_Mandatory_d_Dimer_in_the_Evaluation_of_Suspected_Pulmonary_Embolism_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1546-1440(18)30536-2 DB - PRIME DP - Unbound Medicine ER -