PB1007 - Diagnostic yield of imaging for pulmonary embolism by presenting complaint in the emergency department: an observational study.

Monday, June 26, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Federico Germini, MD, MSc, PhD

Assistant Professor
Department of Medicine, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada

Co-Author(s)

FA

Fayad Al-haimus

Emergency Medicine Resident
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON
Toronto, Ontario, Canada
YH

Yang Hu

Undergraduate Student
Department of Medicine, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada
JK

Joshua Klyn

Undergraduate Student
Department of Medicine, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada
RI

Rick Ikesaka

Assistant Professor
Department of Medicine, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada
Noel Chan, FRACP, FRCPA

Associate Professor
Department of Medicine, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada
NC

Natasha Clayton

Clinical Trial Manager
Department of Medicine, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada
QI

Quazi Ibrahim

Statistician
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada
Kerstin de Wit, MBChB, MSc, MD, MRCP, FRCEM, FRCPC

Associate Professor
Department of Emergency Medicine, Queen’s University
Kingston, Ontario, Canada

Background: Despite contrary efforts, the use of imaging to rule out pulmonary embolism (PE) in the emergency department (ED) is constantly increasing. The patient presenting complaint might influence the emergency physician’s threshold for requesting imaging. We hypothesized the threshold to test for PE is lower in patients with “chest pain with cardiac features”.

Aims: To determine whether the positive yield of PE imaging in ED patients is lower for patients with “chest pain with cardiac features” as compared with other presenting complaints.

Methods: We performed a retrospective study including all adult patient visits between 2018 and 2019 in three EDs in Hamilton, Canada. The presenting complaint was determined at triage, based on the Canadian Emergency Department Information Systems (CEDIS) Presenting Complaint List. The primary outcome was the diagnostic yield of imaging [computed tomography pulmonary angiography (CTPA) or ventilation/perfusion (V/Q) scan]. We performed a multivariable regression analysis using a generalized linear model, adjusting for confounders (age, sex, time of the day, time of the week, study site, D-dimer value).

Results: 518,787 patients presented to the study sites during the study and 6,331 received imaging to rule out a PE. The prevalence of PE including a 30-day follow-up was 0.10% in the general population, 0.21% in patients presenting with “Chest pain with cardiac features”. Overall, the diagnostic yield of imaging was 8.1% (510 positive imaging). The diagnostic yield of imaging for people with the presenting complaint “Chest pain with cardiac features” was 4.5%; for all the other presenting complaints 9.2%, with an adjusted odds ratio of 0.64 (95% confidence interval: 0.46, 0.89, Table 1).

Conclusion(s): The threshold for ordering imaging in patients presenting to the ED with chest pain with cardiac features is lower than the in other patients. Interventions aimed at reducing the use of CTPA in the ED should take this into account.