Effect of Inappropriate Use of Computed Tomography Pulmonary Angiography on the Time Spent in the Emergency Department
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Abstract
Introduction: Chest CT angiography (CTA) is widely used in Emergency Departments (ED) to evaluate syndromes such as pulmonary embolism (PE). However, evidence shows low positivity rates, suggesting that its use is not always justified. The objective of this study is to quantify the positivity rate, identify potentially inappropriate studies requested as CTA, and assess their impact on ED length of stay.
Materials and methods: This retrospective study was approved by the institutional ethics committee. All CTA studies requested for suspected PE between April-June 2022 were reviewed. Data collected included indication, results, D-dimer levels (when available), and time intervals: from arrival to request, from request to performance, reporting time, and from result to discharge or hospitalization. Statistical analyses were performed according to presence or absence of PE.
Results: 506 CTA studies were analyzed, with a mean age of 59.8 years (SD 20) and 58.7% women. PE was diagnosed in 14.6% of cases. Only 13.2% of patients had a D-dimer test prior to CTA (with no significant differences according to PE status). The median time from arrival to request was 64.6 minutes (IQR78), and the median time from CTA performance to report was 24 minutes (IQR 20). No significant differences were observed in these intervals based on PE presence. Median total ED length of stay was 333.3 minutes (IQR 331.16), with significantly longer stays in patients without PE (p<0.01).
Conclusion: Using CTA as a screening tool without robust clinical assessment or laboratory support leads to resource overuse and prolongs ED bed occupancy.
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