A new diagnostic algorithm may be able to reduce hospital costs by appropriately analyzing which patients with suspected pulmonary embolisms need to undergo computed tomography pulmonary angiography procedures, according to a new study.
The new algorithm can reduce the need for CTPA by up to 14%, according to findings from the study, which reduces the patients’ exposure to radiation and saves them from the risk of contrast-induced nephropathy, according to findings from the Years study.
“The advantage of the Years algorithm over existing algorithms is a 14% reduction in the need for CTPA imaging and with that, reduced potential for radiation-induced harm and overdiagnosis,” study investigator Dr. Tom van der Hulle of the Netherlands’ Leiden University Medical Center said in prepared remarks.
The new clinical rule consists of a blood test, checking for clinical signs of deep vein thrombosis, hemoptysis and taking into account if the clinician believes that PE is the “most likely diagnosis,” according to the report.
The study evaluated use of the algorithm in 3,465 patients to decide which patients should be referred for CTPA tests. Patients who were excluded were left untreated and followed for 3 months, while PE patients were treated with anticoagulants.
At 3 months, rates of symptomatic venous thromboembolisms were 0.43% in patients who had PE excluded based on the algorithm alone and 0.84% for patients who had PE excluded based on CTPA.
“This is fully in line with that observed in studies using traditional, sequential algorithms such as the 2-level Wells score, and a fixed cut-off level of D-dimer of 500 ng/mL. Using the Years algorithm, CTPA was not indicated in 48% of our patients at baseline, but this would have been only 34% of patients using the traditional algorithm. This shows that the Years algorithm can safely exclude PE and resulted in an absolute reduction of required CPTA of 14%. We expect that the Years algorithm can be easily implemented outside the participating study sites, and that these safety and efficacy outcomes are representative of what could be expected in regular clinical settings,” Dr. van der Hulle said in a prepared statement.