Using the recommendations of the American College of Physicians (ACP) when receiving cancer patients admitted to the emergency room, which may have pulmonary embolism (PE), can reduce the need for procedures such as CT angiography of the pulmonary arteries.
According to scientists, the recommendations of ACP «to assess the expected pulmonary embolism based on the rule-making and clinical levels of D-dimer in plasma, work well in patients with cancer." By following these recommendations, you can reduce the number of unnecessary procedures CT protocol LE and laboratory studies.
Timely and accurate detection of the LE is of great clinical importance, and CT angiography is needed to diagnose the condition. Nevertheless, a number of organizations approved the avoidance of CT angiography in patients admitted to the emergency department with a low probability of PE predtestirovaniyu. ACP recommends the use of proven clinical prediction tools, such as the scale and Wells exclusion criteria pulmonary emboli combined with levels of D-dimer exactly to determine the need for CT angiography.
The researchers examined data on 380 cancer patients who underwent CT angiography for the three-month period. Diagnostic examination of each patient was evaluated for compliance with the directive ACP, clinical risk determined by the stratification and age-adjusted level of D-dimer and the extent to which these factors have been associated with pulmonary embolism.
Only 56% of patients underwent CT angiography in accordance with the recommendations of ACP. At the same time, 21% were subjected to unnecessary CT procedure, despite the fact that the level of D-dimer was below the age-adjusted threshold value or at low risk patients was PE under all exclusion criteria LE. Fifty-seven patients were "unnecessary" evaluation of D-dimer, and 71 patients with negative test results of D-dimer have been undetectable CT angiography.
In general, according to the researchers, almost half of the study group was subjected to unnecessary diagnostic testing, which could have been avoided if strict adherence to ACP recommendations.
Pulmonary embolism was observed in six out of 108 (6%) patients at low risk, in 22 of 219 (10%) patients with intermediate risk, and in 13 of 53 (25%) patients with a high risk.
The researchers concluded that only one diagnosis of cancer does not require the patient undergoes a CT angiography. Compliance with ACP recommendations can reduce the number of unnecessary CT angiography procedures, thereby reducing the radiation load on the patient, as well as their financial costs.