E2439. Implementation and Utilization of a CT Abdomen/Pelvis Bleed Protocol
  1. Aaron Reposar; University of Wisconsin
  2. Meghan Lubner; University of Wisconsin
  3. John Garrett; University of Wisconsin
  4. Mark Kleedehn; University of Wisconsin
To evaluate if implementation of a dedicated CT abdomen/pelvis (A/P) bleed protocol increased studies being protocolled as CT-angiograms (CTA) when there was clinical concern for bleeding.

Materials and Methods:
A CTA A/P protocol with noncontrast, arterial, and 70-second parenchymal phases was developed as a CT-bleed protocol. Radiologists were encouraged to use the new protocol via email. Ordering and protocolling information was extracted from the electronic health record two months prior and two months post the go-live date. Indication terms searched included, “active bleed, bleeder, hemorrhage, dropping hemoglobin, hemodynamically unstable, hypotension, bleed, arterial extravasation, arterial bleed, venous bleed, pseudoaneurysm, and/or anything suggestive of active bleeding from the extraction data. Chi-square tests were performed to determine statistical significance.

Twenty-three studies were excluded from the study because bleeding was determined to not be a clinical concern (e.g., known hematoma without concern for active bleeding). Seventy-nine studies met criteria prior to protocol implementation and 117 met criteria after protocol implementation. Before implementation 24% (30%) studies were performed as CTAs (mean Cr 1.25), and after implementation 49 (42%) studies were performed as CTAs (mean Cr 1.75) (p = 0.10). Before implementation 36 (46%) studies were performed as noncontrast CTs (mean creatinine 2.56) and after implementation 35 (30%) studies were performed as noncontrast CTs (mean creatinine 1.76) (p = 0.03). Before implementation 24% (46%) studies were performed as portal venous CTs (mean Cr 1.45) and after implementation 33 (28%) studies were performed as portal venous CTs (mean Cr 2.22) (p = 0.42).

There was a significant decrease in the studies performed as noncontrast examinations after the CT-bleed protocol, with a trend towards more CTAs performed. The number of studies protocolled as portal venous CTs remained largely stable, suggesting further education is necessary on the importance of protocolling studies as CTAs when there is clinical concern for bleeding.