2Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Türkiye
3Department of Intensive Care, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Türkiye
4Department of Public Health, Hacettepe University Faculty of Medicine, Ankara, Türkiye
5Department of Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Türkiye
6Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Türkiye
BACKGROUND AND AIM: The use of computed tomographic pulmonary angiogram (CTPA) without determining pretest probability leads to overuse and morbidities as contrast-induced acute kidney injury (CI-AKI). We aimed to assess the predictive role of Wells’ rule and revised Geneva scores together with the D-dimer test in patients who underwent CTPA for the suspicion of pulmonary embolism (PE) and to investigate the frequency of CI-AKI.
METHODS: This single-center study was conducted as a retrospective analysis of patients who underwent CTPA. Demographic and clinical variables, risk factors, pretest probability score (PPS), and biomarkers were recorded from written or electronic medical records.
RESULTS: A total of 1259 CTPA scans performed for suspicion of acute PE were screened. After exclusion, we analyzed 895 CTPAs. PE rates in the emergency department and in-patient wards were 9.1% and 13.9%, respectively. Immobility, high Wells’ rule, and Geneva scores were found to be predictors of PE. The [OR (95% CI)] were [12.92 (4.38–38.14)], p<0.001; [7.55 (1.96–28.61)], p<0.001; and [1.25 (1.07–1.39)], p=0.003, respectively. The diagnostic sensitivity of Wells’ rule and Geneva score for PE was 24.6% and 68.1%, respectively, while the diagnostic specificity for PE was 91.4% and 42.7% for Wells’ rule and revised Geneva score, respectively. CI-AKI was detected in 99 (20.7%) of 479 patients, and the history of myocardial infarction within 3 months was the only predictor of CI-AKI [OR (95% CI)] [6.30 (1.46–27.90)], p=0.014.
CONCLUSIONS: D-dimer test and usage of PPS for patients considered PE may reduce overuse of CTPA and thereby CI-AKI prevalence.