New pulmonary embolism approach could substantially reduce imaging overuse
A new approach to assessing for pulmonary embolism could substantially reduce the use of diagnostic imaging, according to an analysis published Wednesday in JAMA Cardiology.
Identifying this condition can prove challenging, sometimes leading to the overuse of computed tomography pulmonary angiography. Wanting to address this issue, scientists developed a pretest probability score to make it easier for emergency docs to rule out PE and avoid over-imaging.
Testing out their 4-Level Pulmonary Embolism Clinical Probability Score on two separate sets of data, researchers found early success.
“Applying 4PEPS resulted in a very low rate of diagnostic failure and a substantial reduction in imaging testing,” concluded first author Pierre-Marie Roy, MD, PhD, with the Angers University Hospital Center in France, and colleagues from several other institutions.
The scoring system operates based solely on clinical criteria and optimized D-dimer measurement. It includes four levels of clinical pretest probability for pulmonary embolism ranging from very low to low, moderate, and high. Roy et al. tested the safety and efficacy of the strategy on two retrospective sets of patients—one with a moderate rate of pulmonary embolism and a second with high PE prevalence. They calculated false-negative rates below 1% on both and absolute reductions in imaging use of about 20%.
Further investigation in a formal outcome study may come next. But the study authors believe 4PEP could potentially be integrated into an electronic health record for automated calculation of these scores.
“Using such setups, we believe that 4PEPS will be embraced by ED physicians and will lead to a substantial and safe decrease in imaging testing,” they wrote.
You can read much more about how the system works in the March 3 JAMA Cardiology study here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.