Variability in practice patterns among emergency physicians in the evaluation of patients with a suspected diagnosis of pulmonary embolism.
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To describe the inter-physician variability in the utilisation rate and diagnostic yield of computed tomography pulmonary angiography (CTPA) among a group of emergency department (ED) physicians working in a similar clinical environment.
We collected data on all CTPA studies ordered by ED physicians at three affiliated sites during a 2-year period between January 1, 2016, and December 31, 2017. For each physician, we calculated individual CTPA utilisation rate (total number of CTPAs ordered per 1000 ED visits) and diagnostic yield (percentage of CTPAs that were positive for PE). Additional analysis was carried out in order to identify the highest orderers of CTPA and their diagnostic yield.
Seventy-seven ED physicians who collectively ordered a total of 2788 CTPAs were included in the study. Utilisation rates ranged from 1.1 to 22.2 CTPA per 1000 ED visits (median: 5.2 CTPA/1000 ED visits; 25%ile: 3.6 CTPA/1000 ED visits; 75%ile: 7.9 CTPA/1000 ED visits) and the CTPA diagnostic yields ranged from 0% to 33% (median: 9.1%; 25%ile: 5.2%; 75%ile: 16.1%). Those physicians in the lower quartile for ordering rate had a higher mean diagnostic yield when compared to the higher quartiles.
The findings of this study demonstrate variability in CTPA ordering patterns and diagnostic yields among physicians working within the same clinical environment. There is some suggestion that those physicians who order disproportionately higher numbers of CTPAs have lower diagnostic yields.
KeywordsPulmonary embolism Diagnostic imaging Physicians practice patterns Computed tomography Biomarkers
The authors would like to thank Dr. Oscar Karbi, Mr. Ishmail Sheri, Mr. Daniel Levay, Mr. Shaun Ghanny, Ms. Desa Marin, Ms. Priscilla Matthews and the Brampton Civic Hospital Emergency Department Governance Committee for their contributions to this manuscript. The authors acknowledge support from the CanVECTOR Network; the Network receives grant funding from the Canadian Institutes of Health Research (Funding Reference: CDT-142654).
No external funding was secured for this study. Institutional support was provided by William Osler Health System, the Brampton Civic Hospital Emergency Department Governance Committee, McMaster University Department of Medicine and University of Toronto Department of Family and Community Medicine.
Compliance with ethical standards
Conflict of interest
The authors declare that they have any conflict of interest to report.
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