Document Type : Original Article(s)
Authors
- Vahid Mohammadkarimi 1
- Samaneh Ahsant 2
- Mohammad Hadi Bagheri 3
- Reza Jalli 4
- Ali Hosseinipour 5
- Seyed Masoom Masoompour 6
1 Assistant Professor, Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
2 Resident, Student Research Committee AND Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
3 Professor, Medical Imaging Research Center AND Department of Radiology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
4 Associate Professor, Medical Imaging Research Center AND Department of Radiology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
5 Assistant Professor, Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
6 Professor, Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
BACKGROUND: We evaluated to see if the algorithmic approach of pulmonary embolism (PE) [Wells’ score, followed by D-dimer test and computed tomography pulmonary angiography (CTPA)] is appropriately followed in teaching hospitals of Shiraz, Iran.METHODS: From October 2012 to October 2013, we prospectively calculated Wells’ score for all patients who underwent CTPA with clinical suspicion to PE; patients with low probability who had not checked the D-dimer or had low level of D-dimer were considered as non-adherent to the guideline and those with high level of D-dimer or high probability of Wells’ score were labeled as adherent to the PE guideline. CTPA scans were independently reported by two radiologists.RESULTS: During study period, 364 patients underwent CTPA to rule out PE, of which 125 (34.3%) had Wells’ score > 4 (high probable risk) and 239 had Wells’ score ≤ 4. Amongst low probable risk patients (Wells’ score ≤ 4), only 32 patients had undergone the D-dimer test (23 patients had high level of D-dimer). Based on the algorithmic approach, patients with suspected PE, patients with high probability (125 patients), and patients with low probability with elevated D-dimer level (23 patients) were considered as adherent to the PE guideline; consequently, the total adherence to PE guideline was 148 out of 364 (40.6%).CONCLUSION: We followed the algorithmic approach guideline in about 40.0% of cases; however, we should pay more attention to the algorithmic approach in patients with suspected PE.
Keywords
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