Pulmonary Embolism Clinical Trial
Official title:
Improving the Stewardship of Diagnostic Imaging Resources in Alberta Emergency Departments
Utilization of diagnostic imaging in the Emergency Department has increased dramatically over the past two decades, driven by an increased availability of advanced imaging, legal pressures to exclude serious diagnoses in low-risk patients, patient expectations, and the tendency to associate more testing with a higher quality of care. However, this rise in the use of diagnostic imaging, particularly in low-risk patients, may not be taking into account the risk of radiation exposure to patients, or the impact on finite health system resources. The objective of this project is to improve the appropriateness of CT imaging in Alberta Emergency Departments by advancing awareness of, and adherence to, evidence-based guidelines for CT imaging of patients with mild traumatic brain injury (MTBI) and suspected pulmonary embolism (PE). These two clinical scenarios have been selected because of evidence of significant variation in imaging practices across Alberta, and the robust evidence base that exists to guide CT imaging decisions such as the Canadian CT Head Rule and the Pulmonary Embolism Rule Out Criteria.
Status | Recruiting |
Enrollment | 52058 |
Est. completion date | September 2017 |
Est. primary completion date | September 2017 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | Both |
Age group | 16 Years and older |
Eligibility |
Inclusion Criteria: - Patients: All patients presenting to pre-determined Alberta emergency departments with head injuries and suspected pulmonary embolism will be targeted for evaluation of CT appropriateness. For the CT Head, patients >16 with a CEDIS Triage code of "Head Injury" will be eligible. For the CT Pulmonary Angiography (CTPA) patients age 18-85 with CEDIS Triage codes of "Chest Pain (Noncardiac Features)", "Shortness of Breath", or "Syncope/Presyncope" will be eligible. - Health Professionals: Engagement in this project will fall within the professional responsibilities and mandate for many if not all of these individuals will be supported by zone leadership in each domain. The interventions proposed are educational and voluntary in nature; as there are clinical situations in which clinical judgement is expected to supersede clinical guidelines, and therefore no coercive measures will be taken to impose universal physician compliance. Exclusion Criteria: - Patients under 16 years of age for CT head, under 18 or over 85 years of age for CT pulmonary angiography. |
Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research
Country | Name | City | State |
---|---|---|---|
Canada | Foothills Medical Centre - C231 | Calgary | Alberta |
Canada | Peter Lougheed Centre | Calgary | Alberta |
Canada | Sheldom M. Chumir Centre | Calgary | Alberta |
Canada | South Health Campus | Calgary | Alberta |
Canada | Grey Nuns CommunityHospital | Edmonton | Alberta |
Canada | Royal Alexandra Hospital | Edmonton | Alberta |
Canada | University of Alberta Hospital | Edmonton | Alberta |
Canada | Misericordia Community Hospital | Edmontyon | Alberta |
Canada | Northern Lights Regional Hospital | Fort McMurray | Alberta |
Canada | Fort Saskatchewan Health Centre | Fort Saskatchewan | Alberta |
Canada | Queen Elizabeth II Hospital | Grande Prairie | Alberta |
Canada | Chinook Regional Hospital | Lethbridge | Alberta |
Canada | Medicine Hat Regional Hospital | Medicine Hat | Alberta |
Canada | Red Deer Regional Hospital | Red Deer | Alberta |
Canada | Strathcona Community Hospital | Sherwood Park | Alberta |
Canada | Sturgeon Community Hospital | St. Albert | Alberta |
Lead Sponsor | Collaborator |
---|---|
University of Calgary | Alberta Innovates Health Solutions |
Canada,
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* Note: There are 46 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Proportion of patients with mild traumatic brain injury who undergo a CT head | All presenting patients for a period of 30 months (15 months pre-intervention administrative data, and 15 months of administrative date during the intervention)/ | Yes | |
Primary | Proportion of patients with suspected Pulmonary Embolism who undergo a CTPA scan | All presenting patients for a period of 30 months (15 months pre-intervention administrative data, and 15 months of administrative date during the intervention) | Yes | |
Secondary | Proportion of patients with mild traumatic brain injury who undergo a CT Head for which a CT Head is recommended by the Canadian CT Head Rule | All presenting patients for a period of 30 months (15 months pre-intervention administrative data, and 15 months of administrative date during the intervention) | Yes | |
Secondary | Proportion of patients with suspected pulmonary embolism who undergo a CTPA scan for which a CTPA scan is recommended after applying the Well's Score, the Pulmonary Embolism Rule-Out Criteria (PERC), and receiving D-Dimer test results. | All presenting patients for a period of 30 months (15 months pre-intervention administrative data, and 15 months of administrative date during the intervention) | Yes | |
Secondary | Proportion of patients who return to the ED within 30 days with the same presenting complaint and undergo a CT Head or CTPA | Patients will be followed from presentation to the ED up until 30 days post-discharge from the ED | Yes |
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