Background: Computed tomography pulmonary angiography (CTPA) is frequently used in the emergency department (ED) for the diagnosis of pulmonary embolism (PE), while posing risk for contrast-induced nephropathy and radiation-induced malignancy.
Objective: We aimed to create an automated process to calculate the Wells score for pulmonary embolism for patients in the ED, which could potentially reduce unnecessary CTPA testing.
Methods: We designed an automated process using electronic health records data elements, including using a combinatorial keyword search method to query free-text fields, and calculated automated Wells scores for a sample of all adult ED encounters that resulted in a CTPA study for PE at 2 tertiary care hospitals in New York, over a 2-month period. To validate the automated process, the scores were compared to those derived from a 2-clinician chart review.
Results: A total of 202 ED encounters resulted in a completed CTPA to form the retrospective study cohort. Patients classified as "PE likely" by the automated process (126/202, 62%) had a PE prevalence of 15.9%, whereas those classified as "PE unlikely" (76/202, 38%; Wells score >4) had a PE prevalence of 7.9%. With respect to classification of the patient as "PE likely," the automated process achieved an accuracy of 92.1% when compared with the chart review, with sensitivity, specificity, positive predictive value, and negative predictive value of 93%, 90.5%, 94.4%, and 88.2%, respectively.
Conclusions: This was a successful development and validation of an automated process using electronic health records data elements, including free-text fields, to classify risk for PE in ED visits.
Keywords: clinical decision support systems; electronic health record; health informatics; pulmonary embolism; quality improvement.
©Nasen Jonathan Zhang, Philippe Rameau, Marsophia Julemis, Yan Liu, Jeffrey Solomon, Sundas Khan, Thomas McGinn, Safiya Richardson. Originally published in JMIR Formative Research (https://formative.jmir.org), 28.02.2022.