Clinicians’ Perceptions of the Value of Ventilation-Perfusion Scans

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Abstract

Rationale:

The goal of this investigation was to understand clinicians’ perceptions of the probability of pulmonary embolism as a function of V/Q scan results of normal, low, intermediate, and high probability.

Methods:

A questionnaire was developed and distributed to 429 clinicians at a single academic medical center. The response rate was 44% (188 of 429). The questions included level of training, specialty, probability of PE given 1 of the 4 V/Q scan results, and estimations of the charges for V/Q scanning and pulmonary angiography, and estimations of the risks of pulmonary angiography.

Results:

The medians and ranges for the probability of pulmonary embolism given a normal, low, intermediate, and high probability V/Q scan result were 2.5% (0–30), 12.5% (0.5–52.5), 41.25% (5–75), and 85% (5–100), respectively. Eleven percent (21 of 188) of the respondents listed the probability of PE in patients with a low probability V/Q scan as being 5% or less, and 33% (62 of 188) listed the probability of PE given an intermediate probability scan as 50% or greater. The majority correctly identified the rate of serious complications of pulmonary arteriography, but many respondents underestimated the charge for V/Q scans and pulmonary arteriography.

Conclusions:

A substantial minority of clinicians do not understand the probability of pulmonary embolism in patients with low and intermediate probability ventilation–perfusion scans. More quantitative reporting of results is recommended. This could be particularly important because VQ scans are used less frequently but are still needed in certain clinical situations.

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