4. Electronic Theses and Dissertations (ETDs) - Faculties submissions

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Author: search.filters.author.Sibindlana, Amanda Patiswa

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    Retrospective audit of the appropriate use criteria for ventilation/perfusion imaging in pulmonary embolism in a South African population cohort
    (University of the Witwatersrand, Johannesburg, 2023-09) Sibindlana, Amanda Patiswa; Vangu, Mboyo-Di-Tamba; Malan, Nico; Momodu, Jaleelat
    Background: Venous thromboembolism (VTE) is blood clot formation comprising deep vein thrombosis (DVT) and pulmonary embolism (PE). Stasis, endothelial dysfunction and hypercoagulability place an individual at increased risk for developing DVT. VQ scans are crucial to determine the appropriate treatment in patients. The use of VQ scans is addressed in several clinical scenarios, including pregnancy, renal failure, contrast allergy, haemodynamic instability and abnormal chest X-ray findings. Aim: This study assessed the appropriateness of VQ scan requests received by the nuclear medicine departments at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwanath Academic Hospital (CHBAH). Methods: The appropriateness of referrals and VQ scintigraphy in patients with suspected PE at CMJAH and CHBAH nuclear medicine clinical departments was determined. A retrospective audit was done on the request forms of patients referred for VQ scintigraphy to a diagnose pulmonary embolism over five years from 01 January 2015 to 31 December 2019. The clinical information in the request forms was compared to the appropriate use criteria (AUC) to determine the level of appropriateness and categorised as appropriate, maybe appropriate and rarely appropriate. Statistical software (STATA) was used for data analysis. T-tests were used for continuous variables, and Pearson’s chi-squared tests were used for dichotomous data. A p-value of <0.05 was considered statistically significant. Results: A total of 1167 records were reviewed, and fewer than 50% of the referrals were found to be appropriate overall. There were 440 records that fitted the relevant criteria, 580 were rarely appropriate, and 149 maybe appropriate. The median age of individuals referred was 45 years. Most records were for females, with 321 (73%) falling into the appropriate category. There were 72 (13%) confirmed pregnancies and 17 (24%) were appropriate for a VQ scan. The average D-dimer concentration for these patients was 2.15 mg/L. The average D-dimer concentration was the highest in patients where referrals for VQ scans were considered as maybe appropriate (2.6 mg/L; 1.18 – 6.7) compared to an average D-dimer concentration of 2.5 mg/L (1.35 – 6.78) in patients appropriately referred for VQ scans and 0.68 mg/L (0.41 – 1.51) for patients inappropriately referred for VQ scans. Some patients were still referred for VQ scans to exclude the possibility of PE. Conclusion: The criteria used for referrals in our clinical setting were found insufficient due to the inefficient system and criteria used to refer patients in our clinical setting. This may result from a lack of required information and standardisation of the assessments with which clinicians judge the patient’s risk for PE/VTE. This was the case even in a largely female cohort with many concurrent risk factors.