2 Avoid CT pulmonary angiography in emergency department patients with a low pretest probability of pulmonary embolism and either a negative pulmonary embolism rule-out criteria (PERC) or a negative D-dimer. Advances in medical technology have increased the ability to diagnose even small blood clots in the lung. Now, the most commonly used test is known as a CT pulmonary angiogram (CTPA). It is readily available in most hospitals and emergency departments. However, disadvantages of the CTPA include patient exposure to radiation, the use of dye in the veins that can damage kidneys, and high cost.
3 Avoid lumbar spine imaging in the emergency department for adults with atraumatic back pain unless the patients have severe or progressive neurologic deficits or are suspected of having a serious underlying condition, such as vertebral infection or cancer with bony metastasis. Low back pain without trauma is a common presenting complaint in the emergency department. Most of the time, such pain is caused by conditions such as a muscle strain or a bulging disc that cannot be identified on an X-ray or CT scan.
4 Avoid prescribing antibiotics in the emergency department for uncomplicated sinusitis. Sinusitis is a common reason patients visit the emergency department. Most patients with acute sinusitis do not require antibiotic treatment because 98 percent of cases are caused by a viral infection and resolve in 10–14 days without treatment.