CLINICAL decision support (CDS) systems significantly enhance the diagnostic yield of pulmonary embolism (PE) on CT pulmonary angiogram (CTPA) scans, researchers have reported. “Point-of-order CDS tools to reduce unnecessary CTPA in hospitalised patients resulted in significantly higher PE yield when CDS recommendations were followed,” the researchers noted.
CTPA is a crucial diagnostic tool for suspected PE, but its utilisation has nearly doubled in the past two decades, with diagnostic yield sometimes as low as 3.8%. Such low yields contribute to inefficient use of resources and unnecessary patient exposure to risks, including ionising radiation and iodinated contrast.
CDS tools integrate clinical scoring systems like the PE Rule-Out Criteria (PERC) and Wells Criteria to improve imaging appropriateness, particularly in outpatient and emergency settings. However, their effectiveness in hospitalised patients has remained unclear until now.
The research team conducted a study using a CDS tool based on the Wells Criteria. The study assessed 5,372 CTPA exams performed in the 12 months before (2,943 exams) and after (2,429 exams) CDS implementation, involving 340,146 hospital admissions.
Key findings include:
- Improved PE Yield: Following CDS recommendations yielded a higher PE diagnosis rate (18.3%) compared to disregarding them (14.2%), marking a 29.1% relative increase.
- Reduced Utilisation: CTPA use decreased by 7.4% post-CDS implementation.
- No Yield Change Overall: Pulmonary embolism diagnosis rates remained consistent before and after CDS implementation.
The research underscores the value of CDS tools in optimising imaging use and improving diagnostic outcomes. “[Point]-of-order CDS to reduce unnecessary CTPA in hospitalised patients resulted in a significant decrease in CTPA utilisation post-CDS implementation,” the authors concluded.
This study highlights how integrating clinical decision tools into hospital workflows can enhance efficiency and patient safety in medical imaging.
Reference
Sharma A et al. Impact of a clinical decision support system on computed tomographic pulmonary angiogram yield and utilization in hospitalized patients. J Am Coll Radiol. 2024;DOI:10.1016/j.jacr.2024.11.030.
