Contributions
Abstract: PB1833
Type: Publication Only
Session title: Thrombosis and vascular biology - Biology & Translational Research
Background
Pulmonary embolism remains a worldwide major health problem.1 It is among the most common causes of vascular death after myocardial infarction and stroke, and is the leading preventable cause of death in patients in hospital. Pulmonary embolism (PE) is a life-threatening condition resulting from dislodged thrombi occluding the pulmonary vasculature; right heart failure and cardiac arrest may ensue if not aggressively treated.
Common clinical features include dyspnoea, pleuritic chest pain, and hypoxaemia. There may also be evidence of a concurrent deep vein thrombosis. Hypotension, syncope, tachycardia, and signs of right heart failure are less common signs but are important to recognise as they suggest a high-risk PE with a larger clot burden and a higher mortality rate. Clinical probability, assessed by a validated prediction rule and clinical judgement, is the basis for all diagnostic strategies for PE. Computed tomographic pulmonary angiography is the definitive diagnostic investigation..Haemodynamically unstable patients require urgent primary reperfusion (usually thrombolysis), anticoagulation, and supportive care. Those at intermediate risk of a poor outcome require anticoagulation and ongoing monitoring; rescue reperfusion should be used if patients become haemodynamically unstable.
Aims
Objectives of this audit was to determine compliance rates with NICE CG 144 in diagnosing PE and Re-audited after 1 year to assess improvement in practice
Methods
- First Loop – Notes of 100 patients who were referred for CTPA to radiology department was taken and analysed for clinical features and documentation of wells score and results of CTPA during 2017 . Subsequently results were presented in medical grand round and recommendations were dissipated to medial teams and published in hospital news bulletin. In first loop only in 3% patients Wells score was calculated. While incidence of PE was 14%
- Second loop – Notes of 50 patients who were referred for CTPA to radiology department was taken and analysed for clinical features and documentation of wells score and results of CTPA during 2018 . Again results were presented in medical grand round and recommendations were dissipated to medial teams and published in hospital news bulletin. In 2nd loop wells score was calculated in only 18% of patients and incidence of PE was 22%.
Results
Clinical features of PE in descending order (as per NICE)
- Dyspnoea (70% of patients). 1st 67. 2nd 72 . Tachypnoea (RR >20). Pleuritic Chest pain. 47% 50%
- Apprehension. . Tachycardia (HR >100). 1% -8% . Cough. 1st 7% 2nd 16 %
- Haemoptysis.1st 2% 2nd 8%. Leg Pain. Clinical evidence of DVT (10% of patients). Dizziness 1%>2%
- Majority of patients presented with mix symptoms.
Good clinical history and examination are key factors to establish the diagnosis followed by an appropriate investigation depending on risk stratification
Conclusion
- Difficult to know how many patients warranted CTPA.
- Can assume unnecessary CTPAs have been performed.
- Costly investigation. Radiation – one CTPA = 350 CXRs
- Slight increase in compliance with NICE guidelines ( from 3% to 18%).
Abstract: PB1833
Type: Publication Only
Session title: Thrombosis and vascular biology - Biology & Translational Research
Background
Pulmonary embolism remains a worldwide major health problem.1 It is among the most common causes of vascular death after myocardial infarction and stroke, and is the leading preventable cause of death in patients in hospital. Pulmonary embolism (PE) is a life-threatening condition resulting from dislodged thrombi occluding the pulmonary vasculature; right heart failure and cardiac arrest may ensue if not aggressively treated.
Common clinical features include dyspnoea, pleuritic chest pain, and hypoxaemia. There may also be evidence of a concurrent deep vein thrombosis. Hypotension, syncope, tachycardia, and signs of right heart failure are less common signs but are important to recognise as they suggest a high-risk PE with a larger clot burden and a higher mortality rate. Clinical probability, assessed by a validated prediction rule and clinical judgement, is the basis for all diagnostic strategies for PE. Computed tomographic pulmonary angiography is the definitive diagnostic investigation..Haemodynamically unstable patients require urgent primary reperfusion (usually thrombolysis), anticoagulation, and supportive care. Those at intermediate risk of a poor outcome require anticoagulation and ongoing monitoring; rescue reperfusion should be used if patients become haemodynamically unstable.
Aims
Objectives of this audit was to determine compliance rates with NICE CG 144 in diagnosing PE and Re-audited after 1 year to assess improvement in practice
Methods
- First Loop – Notes of 100 patients who were referred for CTPA to radiology department was taken and analysed for clinical features and documentation of wells score and results of CTPA during 2017 . Subsequently results were presented in medical grand round and recommendations were dissipated to medial teams and published in hospital news bulletin. In first loop only in 3% patients Wells score was calculated. While incidence of PE was 14%
- Second loop – Notes of 50 patients who were referred for CTPA to radiology department was taken and analysed for clinical features and documentation of wells score and results of CTPA during 2018 . Again results were presented in medical grand round and recommendations were dissipated to medial teams and published in hospital news bulletin. In 2nd loop wells score was calculated in only 18% of patients and incidence of PE was 22%.
Results
Clinical features of PE in descending order (as per NICE)
- Dyspnoea (70% of patients). 1st 67. 2nd 72 . Tachypnoea (RR >20). Pleuritic Chest pain. 47% 50%
- Apprehension. . Tachycardia (HR >100). 1% -8% . Cough. 1st 7% 2nd 16 %
- Haemoptysis.1st 2% 2nd 8%. Leg Pain. Clinical evidence of DVT (10% of patients). Dizziness 1%>2%
- Majority of patients presented with mix symptoms.
Good clinical history and examination are key factors to establish the diagnosis followed by an appropriate investigation depending on risk stratification
Conclusion
- Difficult to know how many patients warranted CTPA.
- Can assume unnecessary CTPAs have been performed.
- Costly investigation. Radiation – one CTPA = 350 CXRs
- Slight increase in compliance with NICE guidelines ( from 3% to 18%).