CT Angiography Is More Likely to Be Negative for PE When Ordered for Defensive Reasons

Fear of missing pulmonary embolism was cited as a reason for ordering computed tomography pulmonary angiography in 55% of cases in this single-center Swiss study.


Researchers assessed physicians' reasons for ordering computed tomography pulmonary angiography (CTPA) at a single emergency department in Switzerland during a one-year period (328 CTPAs; 19.2% positive). Physicians received training on estimating pretest probability with the standardized Wells/Geneva score and were asked to calculate a Wells/Geneva score and complete a questionnaire about reasons for ordering CTPA, before ordering the test.

Physicians completed the questionnaire in 43 of cases and calculated the Wells/Geneva score in 53%. The incidence of pulmonary embolism (PE) was 19% overall and was significantly higher in cases with completed questionnaires than in those without (26% vs. 14%). The most common reasons for ordering CTPA were to confirm/rule out PE (93%), elevated D-dimer (66%), and fear of missing PE (55%). Fear of being sued was cited in only 5% of cases. In multivariable logistic regression analysis, calculating the Wells/Geneva score was associated with a positive study (odds ratio, 3.28), whereas citing fear of missing PE as a reason for ordering CTPA was inversely associated with a positive study (OR, 0.36).


Citation(s):

Rohacek M et al. Ordering CT pulmonary angiography to exclude pulmonary embolism: Defense versus evidence in the emergency room. Intensive Care Med 2012 May 15; [e-pub ahead of print].