Consultation and Echocardiography Timing for Duke Health Patients With Pulmonary Embolism Diagnosed Via Computed Tomography

INTRODUCTION Effective treatment of pulmonary embolism (PE), a major cause of mortality, depends on a timely sequence of care. This includes diagnosis via computed tomography (CT) with a protocol-timed contrast agent (CTPE) and possibly right ventricular assessment via echocardiograms (echo). PE Response Teams (PERT) can expedite treatment decisions and interventions. While previous registries have characterized established PE patients or those receiving interventions, the sequence and timing of care for all patients—including CTPE, echocardiograms, and PERT consultations—are poorly characterized. This study aims to characterize the demographics and the sequence of timing of care for all patients diagnosed with PE via CT in a quaternary care hospital system. METHODS CTPE reports were obtained from Duke Health's electronic health record using Epic Clarity. Patient IDs were used to extract relevant Echos within 48 hours of the CTPE. Pulmonary vascular disease (PVD) consultations were identified as PERT consultations if ordered within 48 hours of the CTPE event. RESULTS From 2014 to 2024, Duke Health recorded 82,004 CTPE studies involving 60,567 patients across 80,682 admissions. The mean patient age was 58.27 ± 17.22 years. The majority were Black (38.98%) or White (54.31%), with a significant proportion not Latino (92.98%). The median time from the CTPE order to scan was 1.71 hours [0.93, 3.20]. Among these patients, 19,281 CTPE episodes needed urgent echo, ordered a median 0.13 hours [-0.05, 0.36] after the CTPE, with results documented 0.56 hours [0.27, 0.89] after performing the echo. The total time from CTPE to echo results was 0.77 hours [0.33, 1.10]. Additionally, 479 PVD consults were initiated for 470 patients, with a median time of 0.12 hours [0.03, 0.55] post-CTPE, closely correlating with echo orders at 0.03 hours [-0.04, 0.42]. CONCLUSIONS With these findings, we describe patient demographics and care timelines for CTPE, TTE, and PERT consults at an academic center. This emphasizes the need for coordination for timely PE diagnosis and suggests opportunities for process optimization.

Duke Scholars

Author Krista Lynn Haines Trauma, Acute, and Critical Care Surgery