Premium
Application of an evidence‐based decision rule to patients with suspected pulmonary embolism
Author(s) -
Zwaan Laura,
Thijs Abel,
Wagner Cordula,
Timmermans Daniëlle R. M.
Publication year - 2013
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12019
Subject(s) - medicine , pulmonary embolism , clinical prediction rule , decision rule , clinical judgment , decision aids , radiology , intensive care medicine , surgery , medical physics , artificial intelligence , alternative medicine , computer science , pathology
Rationale To support doctors in diagnosing patients who are suspected to have pulmonary embolism, the C hristopher evidence‐based decision rule was implemented in hospitals in the N etherlands. This study examines whether the C hristopher evidence‐based decision rule is applied in clinical practice. In addition, doctors' considerations for not applying the decision rule are explored. Method Dyspnoea patients were included in the study prospectively. The diagnostic process of the patients with suspected pulmonary embolism, as judged by the treating doctor, was compared with the C hristopher evidence‐based decision rule using patient record reviews. In addition, 14 interviews were conducted with doctors who did not follow the C hristopher evidence‐based decision rule to obtain insights into their considerations. Results In 80 of 247 dyspnoea cases, the treating doctors suspected pulmonary embolism. The C hristopher evidence‐based decision rule was applied in 17 out of 80 cases. In 22 cases, more tests were performed than was suggested by the decision rule [i.e. computer‐assisted tomographic angiography ( CTa ) or d ‐dimer], while in 41 cases fewer tests were performed than suggested by the decision rule. Considerations for not following the decision rule included judging another diagnosis to be more likely and not wanting to expose the patient to CTa radiation. Conclusions The C hristopher evidence‐based decision rule for diagnosing pulmonary embolism was not always followed in everyday clinical practice. Doctors seem to base their diagnostic strategy on their own estimate of the likelihood of pulmonary embolism, rather than the whole decision rule. Better adherence to the decision rule could be beneficial by making doctors aware that pulmonary embolism is more likely than they initially thought. However, in a substantial number of cases, it seemed justifiable that doctors deviated from the decision rule. Therefore, further research is needed to determine the value of the C hristopher evidence‐based decision rule in clinical practice.