MedStar Investigators Examine Computed Tomography Pulmonary Angiography in the Emergency Department

Recently published collaborative research examined utilization patterns and predictors of computed tomography pulmonary angiography (CTPA) results in the emergency department. “High Scan Volume with Low Positive Scan Rate in Highest Utilizers: Computed Tomography Pulmonary Angiography in the Emergency Department” was published in The Journal of Emergency Medicine. This publication was the result of the Summer Research Student program with MedStar Health investigators mentoring rising second-year medical students from the Georgetown University School of Medicine. The team included investigators from MedStar Good Samaritan Hospital, MedStar Union Memorial Hospital, MedStar Washington Hospital Center and Georgetown University.

The overutilization of CTPA is a serious concern in the emergency department because the potential of increased risk for radiation exposure, cost, and over diagnosis bias may occur. This study reviewed all CTPA studies performed in one year across a multisite medical system and focused on data for emergency department attendings and positive CTPA scan rates (PSR). The team manually reviewed all applicable scans and classified them as positive, negative, or indeterminate.

The results show there were 10,032 total scans from the emergency department and 6,168 of those were ordered by 153 emergency department attendings. Most attendings (123/153; 80%) ordered 60 or fewer scans, with relatively high PSR (259/2927, PSR 8.8%; 95% confidence interval 7.8–9.9%). Of the emergency department attendings, 13 (3%) ordered more than 100 scans each (1981 scans; 32% of all scans), with PSR of 5.5% (95% confidence interval 4.5–6.5%).

Overall, the study found that most emergency department attendings were low-to mid-volume utilizers of CTPA and had a relatively high PSR. However, the small percentage of attendings who ordered more than 100 scans each accounted for a large percentage of the total number of scans and had a relatively low PSR. These findings suggest that mentoring and/or sharing of performance feedback and best practices in the highest utilizers could help to improve CTPA PSR in the emergency department. 

Dr. David Weisman, a mentor for the Scholars program and senior author for the publication shared his thoughts on the students and the program.  “I’ve have been extremely fortunate to have had the opportunity to work with so many wonderful Georgetown medical students for the past 4 years. Each student brings to the table their individual uniqueness and talents. I’ve been thankful and impressed by the dedication of MedStar Health and Georgetown University leadership to support this program which is so vital to introduce students to research early in their career. I look forward too many more years of collaboration and mentorship.”

The research team included Himanshu Rawal, MD; Oluwatoyosi Ipaye, MS; Amit D. Kalaria, MD; Radhika Vij, MD, FACP; Jeffrey S. Dubin, MD, MBA; Lyn Camire, MA, ELS; and David S. Weisman, DO, FACP.

The Journal of Emergency Medicine, 2020. DOI: 10.1016/j.jemermed.2020.04.008