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Research Letter
Less Is More
March 2018

Association of Lower Diagnostic Yield With High Users of CT Pulmonary Angiogram

Author Affiliations
  • 1Department of Radiology, McGill University Health Centre, Montréal, Québec, Canada
  • 2Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
  • 3Department of Emergency Medicine, McGill University Health Centre, Montréal, Québec, Canada
JAMA Intern Med. 2018;178(3):412-413. doi:10.1001/jamainternmed.2017.7552

Pulmonary embolism (PE) can be life-threatening and, when suspected, is usually investigated by computed tomographic pulmonary angiogram (CTPA). Concerns related to overutilization and harmful ionizing radiation have identified CTPA as an area in need of resource stewardship.1,2 The purpose of this study was to explore interphysician variability in CTPA diagnostic yield and to identify any associated physician characteristics that could inform an intervention to reduce overuse in our institution.

We retrospectively reviewed all CTPAs at an academic teaching hospital in Montreal, Quebec, Canada, from September 2014 to January 2016. Studies were classified as positive or negative; indeterminate examinations, and those performed for chronic pulmonary emboli were excluded. A total of 1394 examinations ordered by 182 physicians were included, of which 199 (14.3%) were positive and 1195 (85.7%) were negative. A multivariable logistic regression analysis was performed to explore whether physician specialty, years in practice, physician sex, or total numbers of studies ordered per physician were associated with CTPA diagnostic yield. We used a generalized estimating equations (GEE) approach to account for patients who underwent repeated examinations over the study period.3 Statistical tests of hypothesis were 2-sided with a significance of P ≤ .05. All analyses were performed using SAS statistical software (version 9.4, SAS Institute Inc). The McGill University Health Centre research ethics board approved this study.

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