Hand-Held Devices Could Improve Diagnosis of Pulmonary Embolism

Researchers at Angers University (France) conducted a cluster-randomized trial in 20 emergency departments in France, which in the first phase involved 1,103 consecutive outpatients with suspected PE. In these patients, healthcare providers grew accustomed to inputting clinical data into handheld devices, followed by investigators who assessed the baseline testing. In the next phase, emergency departments were randomly assigned to activation of a decision-support system on the devices (10 centers, 753 patients) or to the use of posters and pocket cards that showed validated diagnostic strategies (10 centers, 1,015 patients). The primary outcome was appropriateness of diagnostic work-up (defined as any sequence of tests that yielded a post-test probability less than 5% or greater than 85%), and the secondary outcome was defined as strict adherence to guideline recommendations or the number of tests per patient.

The results showed that the proportion of patients who received appropriate diagnostic work-ups was greater during the trial than in the pre-intervention period in both groups, but the increase was greater in the computer-based guidelines group (19.3%). Among patients with appropriate work-ups, those in the computer-based guidelines group received slightly fewer tests than did patients in the paper guidelines group. The study was published in the November 17, 2009, issue of Annals of Internal Medicine.

"The results showed that using the electronic decision-support tools significantly improves diagnostic decision making for suspected pulmonary embolism in emergency departments,” concluded lead author Pierre-Marie Roy, M.D., Ph.D., and colleagues of the Angers University Hospital Center.

PE is a life-threatening condition most often caused by a blood clot breaking off from a vein and entering the circulatory system. The diagnosis of PE is based primarily on validated clinical criteria combined with selective testing, since the typical clinical presentation (shortness of breath, chest pain) cannot be definitively differentiated from other causes. The decision to do medical imaging is usually based on clinical grounds, i.e., the medical history, and symptoms and findings on physical examination, followed by an assessment of clinical probability. But while evidence-based guidelines exist to help physicians safely and efficiently evaluate patients with suspected PE, testing often differs from what is suggested.

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