Comparing ‘clinical hunch’ against clinical decision support systems (PERC rule, wells score, revised Geneva score and YEARS criteria) in the diagnosis of acute pulmonary embolism
Abstract Background Pulmonary embolism (PE) is a common and potentially life-threatening condition. Since it is considered a ‘do not miss’ diagnosis, PE tends to be over-investigated beyond the evidence-based clinical decision support systems (CDSS), which in turn subjects patients to unnecessary ra...
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-022-02242-1 |
| _version_ | 1811211038651056128 |
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| author | Koshiar Medson Jimmy Yu Lovisa Liwenborg Peter Lindholm Eli Westerlund |
| author_facet | Koshiar Medson Jimmy Yu Lovisa Liwenborg Peter Lindholm Eli Westerlund |
| author_sort | Koshiar Medson |
| collection | DOAJ |
| description | Abstract Background Pulmonary embolism (PE) is a common and potentially life-threatening condition. Since it is considered a ‘do not miss’ diagnosis, PE tends to be over-investigated beyond the evidence-based clinical decision support systems (CDSS), which in turn subjects patients to unnecessary radiation and contrast agent exposure with no apparent benefits in terms of outcome. The purpose of this study was to evaluate the yield of ‘clinical hunch’ (gestalt) and four CDSS: the PERC Rule, Wells score, revised Geneva score, and Years criteria. Methods A review was conducted on the Electronic Medical Records (EMR) of 1566 patients from the Emergency Department at a tertiary teaching hospital who underwent CTPA from the 1st of January 2018 to the 31st of December 2019. The scores for the four CDSS were calculated retrospectively from the EMR data. We considered that a CTPA had been ordered on a clinical hunch when there was no mention of CDSS in the EMR, and no D-dimer test. A bypass of CDSS was confirmed when any step of the diagnostic algorithms was not followed. Results Of the total 1566 patients who underwent CTPA, 265 (17%) were positive for PE. The diagnosis yield from the five decision groups (clinical hunch and four CDSS) was as follows—clinical hunch, 15%; PERC rule, 18% (6% when bypassed); Wells score, 19% (11% when bypassed); revised Geneva score, 26% (13% when bypassed); and YEARS criteria, 18% (6% when bypassed). Conclusion Clinicians should trust the evidence-based clinical decision support systems in line with the international guidelines to diagnose PE. |
| first_indexed | 2024-04-12T05:06:07Z |
| format | Article |
| id | doaj.art-6a0f016a67d04dfdba3fb43b64b06a4a |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-04-12T05:06:07Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-6a0f016a67d04dfdba3fb43b64b06a4a2022-12-22T03:46:53ZengBMCBMC Pulmonary Medicine1471-24662022-11-012211710.1186/s12890-022-02242-1Comparing ‘clinical hunch’ against clinical decision support systems (PERC rule, wells score, revised Geneva score and YEARS criteria) in the diagnosis of acute pulmonary embolismKoshiar Medson0Jimmy Yu1Lovisa Liwenborg2Peter Lindholm3Eli Westerlund4Department of Physiology and Pharmacology, Karolinska InstitutetDepartment of Imaging and Physiology, Cardiothoracic Section, Karolinska University HospitalDepartment of Physiology and Pharmacology, Karolinska InstitutetDepartment of Physiology and Pharmacology, Karolinska InstitutetDepartment of Clinical Sciences, Karolinska InstitutetAbstract Background Pulmonary embolism (PE) is a common and potentially life-threatening condition. Since it is considered a ‘do not miss’ diagnosis, PE tends to be over-investigated beyond the evidence-based clinical decision support systems (CDSS), which in turn subjects patients to unnecessary radiation and contrast agent exposure with no apparent benefits in terms of outcome. The purpose of this study was to evaluate the yield of ‘clinical hunch’ (gestalt) and four CDSS: the PERC Rule, Wells score, revised Geneva score, and Years criteria. Methods A review was conducted on the Electronic Medical Records (EMR) of 1566 patients from the Emergency Department at a tertiary teaching hospital who underwent CTPA from the 1st of January 2018 to the 31st of December 2019. The scores for the four CDSS were calculated retrospectively from the EMR data. We considered that a CTPA had been ordered on a clinical hunch when there was no mention of CDSS in the EMR, and no D-dimer test. A bypass of CDSS was confirmed when any step of the diagnostic algorithms was not followed. Results Of the total 1566 patients who underwent CTPA, 265 (17%) were positive for PE. The diagnosis yield from the five decision groups (clinical hunch and four CDSS) was as follows—clinical hunch, 15%; PERC rule, 18% (6% when bypassed); Wells score, 19% (11% when bypassed); revised Geneva score, 26% (13% when bypassed); and YEARS criteria, 18% (6% when bypassed). Conclusion Clinicians should trust the evidence-based clinical decision support systems in line with the international guidelines to diagnose PE.https://doi.org/10.1186/s12890-022-02242-1Pulmonary embolismClinical decision support systemsCTPADiagnosticsWells scorePERC rule |
| spellingShingle | Koshiar Medson Jimmy Yu Lovisa Liwenborg Peter Lindholm Eli Westerlund Comparing ‘clinical hunch’ against clinical decision support systems (PERC rule, wells score, revised Geneva score and YEARS criteria) in the diagnosis of acute pulmonary embolism BMC Pulmonary Medicine Pulmonary embolism Clinical decision support systems CTPA Diagnostics Wells score PERC rule |
| title | Comparing ‘clinical hunch’ against clinical decision support systems (PERC rule, wells score, revised Geneva score and YEARS criteria) in the diagnosis of acute pulmonary embolism |
| title_full | Comparing ‘clinical hunch’ against clinical decision support systems (PERC rule, wells score, revised Geneva score and YEARS criteria) in the diagnosis of acute pulmonary embolism |
| title_fullStr | Comparing ‘clinical hunch’ against clinical decision support systems (PERC rule, wells score, revised Geneva score and YEARS criteria) in the diagnosis of acute pulmonary embolism |
| title_full_unstemmed | Comparing ‘clinical hunch’ against clinical decision support systems (PERC rule, wells score, revised Geneva score and YEARS criteria) in the diagnosis of acute pulmonary embolism |
| title_short | Comparing ‘clinical hunch’ against clinical decision support systems (PERC rule, wells score, revised Geneva score and YEARS criteria) in the diagnosis of acute pulmonary embolism |
| title_sort | comparing clinical hunch against clinical decision support systems perc rule wells score revised geneva score and years criteria in the diagnosis of acute pulmonary embolism |
| topic | Pulmonary embolism Clinical decision support systems CTPA Diagnostics Wells score PERC rule |
| url | https://doi.org/10.1186/s12890-022-02242-1 |
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