Table 1. Examples of AUC scores for V/Q Imaging Most Relevant to Emergency Department Patients
| Clinical Scenario | AUC Score for V/Q |
|---|---|
| Suspicion for PE unlikely, D-dimer negative | 1 |
| Suspicion for PE likely, D-dimer negative | 8 |
| Suspicion for PE unlikely, D-dimer positive | 8 |
| Suspicion for PE likely, patient at risk for contrast complication | 9 |
| Suspicion for PE likely, pregnant patient with normal/mild abnormal chest radiograph, low-dose perfusion scan only | 9 |
Pretest probability of PE determined to be “likely” or “unlikely” based on clinician gestalt or a clinical prediction instrument. AUC score ranges from 1 (rarely appropriate) to 9 (appropriate).
Source: Adapted from J Nucl Med. 2017;58(5):13N-15N.
In summary, emergency physicians should consider AUC for V/Q scans when evaluating patients with suspected PE. Doing so has the potential to decrease variability of care. The implementation of PAMA is inevitable, and other payers who are not using AUCs to assess utilization appropriateness soon will be. ACEP’s involvement in the development and endorsement of additional imaging AUCs relevant to care delivered in the emergency department remains vital.
References
- Protecting Access to Medicare Act of 2014 §218(b,d), 29 USC §1305 note (2014). Promoting evidence-based care. (q) Recognizing appropriate use criteria for certain imaging services. Accessed Sept. 17, 2017.
- Waxman AD, Bajc M, Brown M, et al. Appropriate use criteria for ventilation-perfusion imaging in pulmonary embolism: summary and excerpts. J Nucl Med. 2017;58(5):13N-15N.
Dr. Torbati is associate professor of emergency medicine and co-chairman and medical director of the Ruth and Harry Roman Emergency Department at Cedars-Sinai Medical Center in Los Angeles.
Dr. Brown is professor and chair of emergency medicine at Michigan State University College of Human Medicine in East Lansing.
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