Another decision-support in the Emergency Department paper.
Basically, in this study, an emergency physician considered the diagnosis of pulmonary embolism – and a computerized intervention forced the calculation of a Wells score to help guide further evaluation. Clinicians were not bound by the recommendations of the Wells calculator to guide their ordering. And they sure didn’t. There were 229 patients in their “post-intervention” group, and 26% of their clinicians said that evidence-based medicine wasn’t for them, and were “non-compliant” with their testing strategy.
So, did the intervention help increase the number of positive CTAs for PE? Officially, no – their trend from 8.3% positive to 12.7% positive didn’t meet significance. Testing-guideline complaint CTA positivity was 16.7% in the post-intervention group, which, to them, validated their intervention.
It is interesting that a low-risk Wells + positive d-Dimer or high-risk Wells cohort had only a 16% positive rate on a 64-slice CT scanner – which doesn’t really match up with the original data. So, I’m not sure exactly what to make of their intervention, testing strategy, or ED cohort. I think the take home point is supposed to be, if you you can get evidence in front of clinicians, and they do evidence-based things, outcomes will be better – but either this just was too complex a clinical problem to tackle to prove it, or their practice environment isn’t externally valid.