E2637. What Are the Current CTPA Ordering Trends in the Emergency Department: Are They Increasing and Did They Increase as a Result of COVID-19?
  1. Jason Seidel; Memorial University
  2. Angus Hartery; Memorial University
Within the last 10 years the ordering trends for pulmonary angiogram computed tomography been increasing. This study was to establish if there was any difference in CTPA ordering trends between February 2020 – January 2022 (the months that COVID-19 had the greatest active impact on local public health guidelines/mandates) with the hypothesis that COVID-19s prothrombotic nature will lead to increased ordering trends. The positive diagnostic rate will also be compared against a baseline positive diagnosis rate of approximately 10-15%, established in literature.

Materials and Methods:
Retrospective analysis was performed on all CTPA studies ordered by 3 local tertiary care emergency rooms to rule out pulmonary embolus. Inclusion criteria was any CTPA study ordered by the emergency department for this reason between February 2020 – February 2022. Data collected from the most active months of COVID-19 infection were compared to other years prior to the pandemic to assess for significant changes in ordering trends. Studies were stratified by: Patient age, sex, time of study, indication, and final radiologist diagnosis.

CTPA ordering trends demonstrated a significant increase from 534 performed in 2018 - 2019 to 657 in 2021 - 2022. Positive diagnosis of pulmonary embolus varied from 15.8 - 19.5%. Despite the increased coagulopathy associated with COVID-19 infection, the local ordering trends for CTPA studies did not increase significantly during the main two years of the COVID-19 pandemic.

There has been increase in the number of CTPA studies ordered by the local emergency departments, however no significant difference was noted in the ordering trends during the most active COVID-19 years when compared against the two years prior to the pandemic. Local positive diagnostic rates of thrombus on CTPAs ordered by the emergency department were slightly higher than the average established in the literature. These low percentages could be used to help guide clinical ordering trends. No impact on ordering trends was noted during peak COVID-19 months.