Examination of hospital referral practices for CT pulmonary angiography

Guidelines for the evaluation of venous thromboembolism (VTE) include a history and physical examination in conjunction with computed tomographic pulmonary angiography (CTPA), Doppler ultrasonography, and D-dimer measurements. We performed a retrospective analysis to evaluate the diagnostic yield of CTPA at our facility. Patients between the ages of 18 and 100 with a CTPA completed through the emergency department and/ or any inpatient service over a 6-month period were reviewed and a retrospective Simplified Wells Score was calculated. Three hundred and three patients underwent CTPA for acute VTE. A Simplified Wells Score was calculated for 279 subjects, with a mean score of 1.6 ± 1.6. Twenty CTPA procedures demonstrated VTE, a positive rate of 7.2%, which was lower than expected. This result likely reflects lack of adherence to a clinical algorithm for assessment of VTE and an overly cautious approach to symptom evaluation.