Justin Aunger, PhD, and Kay Por Yip, MBChB, PhD, discuss their research into interventions for improving adherence to clinical guidelines for the management and follow-up of pulmonary nodules.

IntroductionInternational guidelines recommend systemic thrombolysis for high-risk acute pulmonary embolism (PE). Significant uncertainties remain regarding thrombolysis in non high-risk PE and the use of reduced-dose thrombolysis. To address this, United Kingdom (UK) respiratory trainees led a multicentre UK-wide study assessing current practice. Our primary aim was to evaluate UK practice against the European Society of Cardiology (ESC) recommendations (specifically to utilise full-dose thrombolysis only in high-risk PE). Secondary outcomes included mortality and an analysis of clinical factors associated with administrating reduced-dose thrombolysis.MethodRetrospective multicentre observational study evaluating thrombolysis of acute PE from September 2021 to September 2022 in 26 centres across the UK.ResultsA total of 174 patients from 26 sites were included, with fibrinolytic dose recorded in 168 (96.6%) cases. After exclusion of 30 cases involving cardiac arrest, 26/138 patients (18.8%) received reduced-dose thrombolysis. Sixty-seven (39.9%) patients underwent thrombolysis for non high-risk PE. Factors associated with receiving reduced-dose thrombolysis included higher age (p= 0.005), higher Charlson Co-morbidity Index (CCI) (p=0.008) and higher serum lactate (p= 0.02).ConclusionPE thrombolysis in the UK deviates from international guidelines in a significant minority of cases; comprising the use of reduced-dose regimens and thrombolysis in non-high risk cases without haemodynamic deterioration. Prospective real-world studies, assessing clinical practise and outcomes following thrombolysis, should be conducted to understand the pragmatic application of evidence, and inform future guidelines.

There was significant variation in achieved follow-up rates across interventions; however, tracking systems appeared most effective in improving patient follow-up. Review limitations included high ris...