Efficacy evaluation of clinical prediction rules to reduce diagnostic time of venous thromboembolism in the emergency department: a quasi-experimental study

Abstract

Background: venous thromboembolism (VTE) is a habitual urgency attended most frequently in emergency departments. It is the third cause of cardiovascular disease and its main manifestations are deep vein thrombosis and pulmonary embolism. VTE has severe complications and can be life-threatening. That is why a fast and accurate diagnosis is needed. To ensure it, there exist clinical prediction rules that combined with diagnostic algorithms, make diagnosis safer and reduces the number of false-positive and false-negative results. Nevertheless, it is been demonstrated that these diagnostic recommendations are not followed for physicians although they have been validated as the most accurate strategy. Justification: lack of use of clinical prediction rules lead to a clinical practice that is not as safe as when they are used as well as an overuse of unnecessary diagnostic tests (that have important secondary effects such as radiation). One of the main causes for physicians to not using them may be the lack of awareness and training regarding clinical pre-test probability assessment with these scores. This is the reason why the study intervention will be the implementation of VTE diagnosis formation which will be carried in Hospital Universitari Josep Trueta. Objectives: the main purpose of this study is to demonstrate if the use of clinical prediction rules (Wells score) reduces patients’ time spent until they are correctly diagnosed. Secondarily, this study will assess whether the application of Wells score reduces the number of complementary requests in patients with suspected VTE. Methodology: our study is designed as a quasi-experimental before and after evaluation that will be conducted in the emergency department of Hospital Universitari Josep Trueta between November 2019 – November 2022. Formation intervention will be implemented to physicians who work in the emergency department to improve VTE diagnostic process. A non-probabilistic consecutive sampling will be used and there will be needed a 316 patient’s recruitment, needing 158 patient’s recruitment in each period (pre and post-intervention). Time until achieving VTE diagnosis before and after the intervention will be assessed and compared to determine the impact of the intervention. Statistical analysis will be adjusted for possible confounding variables