Utilization of wells score in CT pulmonary angiography for the diagnosis of pulmonary embolism in SASMEC @ IIUM

Abstract

Current evidence suggests computed tomography pulmonary angiography (CTPA) for diagnosis of pulmonary embolism (PE) is overutilized. This study was conducted to assess the utilisation of Wells score and diagnostic yield of CTPA in a single centre in Malaysia. In this cross-sectional study, we retrospectively analysed the CTPA dataset of patients from May 2017 to July 2021. A modified Wells score was used to determine if the imaging study was justified. Descriptive statistics, chi-square tests, and binary logistic regression were used for data analysis. A total of 361 patients underwent CTPA, among whom 107 (29.6%) patients were diagnosed with PE. There were 130 patients in the PE unlikely group who underwent imaging and 27.1% of them were positive for PE. A total of 52 patients in the low probability group underwent imaging and only 7.5% were diagnosed with PE. Among those who had positive D-dimer, PE was diagnosed in only 2.2% with a low Wells score. The Wells score was utilised in 78.5% of the cases. However, the local guideline was only followed in 32.1% of cases. The proportion of PE positive results was among the highest compared to the previous studies. Hence, CTPA was not overutilized, the resources were appropriately used, and the indication was justified for most patients. However, there was a significant deviation from the local guideline.