Strategies to Reduce Advanced Imaging in Antenatal Pulmonary Embolism Diagnostics

How are evidence-based strategies to reduce use of advanced imaging for pregnant patients undergoing pulmonary embolism (PE) diagnostics applied in community practice?This cohort study of 720 patient encounters across 21 hospitals in an integrated health system found substantial underuse of D-dimer to safely rule out PE in labor and delivery units compared with emergency departments (19 of 84 [23%] vs 504 of 620 [81%]) and in third-trimester compared with first-trimester patients (159 of 268 [59%] vs 135 of 159 [85%]). Compression ultrasonography was overused in patients without leg symptoms with low yield (0 of 183).These findings suggest that opportunities exist to improve efficient and effective use of guideline-recommended imaging-reducing strategies in antenatal PE diagnostics.

Corresponding Author: David R. Vinson, MD, Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, 1600 Eureka Rd, Roseville, CA 95661 (drvinson@health.ucdavis.edu).

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