Kanako K Kumamaru1, Andetta R Hunsaker2, Hiraku Kumamaru3, Elizabeth George2, Arash Bedayat2, Frank J Rybicki4. 1. Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA. 2. Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA. 3. Department of Epidemiology, Harvard School of Public Health, Boston, MA. 4. Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA. Electronic address: frybicki@partners.org.
Abstract
BACKGROUND: Despite a general consensus that rapid communication of critical radiology findings from radiologists to referring physicians is imperative, a possible association with superior patient outcomes has not been confirmed. The objective of this study was to evaluate the correlation between early direct communication of CT image findings by radiologists to referring physicians and better clinical outcomes in patients with acute pulmonary embolism (PE). METHODS: This was a retrospective, single-institution, cohort study that included 796 consecutive patients (February 2006 to March 2010) who had acute PE confirmed by CT pulmonary angiography (CTPA) and whose treatment had not been initiated at the time of CTPA acquisition. The time from CTPA to direct communication of the diagnosis was evaluated for its association with time from CTPA to treatment initiation and with 30-day mortality. Cox regression analysis was performed with inverse probability weighting by propensity scores calculated using 20 potential confounding factors. RESULTS: In 93.4% of patients whose first treatment was anticoagulation, the referring physicians started treatment after receiving direct notification of the diagnosis from the radiologist. Late communication (> 1.5 h after CTPA; n = 291) was associated with longer time to treatment initiation (adjusted hazard ratio [HR], 0.714; 95% CI, 0.610-0.836; P < .001) and higher all-cause and PE-related 30-day mortality (HR, 1.813; 95% CI, 1.163-2.828; P = .009; and HR, 2.625; 95% CI, 1.362-5.059; P = .004, respectively). CONCLUSIONS: Delay (> 1.5 h of CTPA acquisition) in direct communication of acute PE diagnosis from radiologists to referring physicians was significantly correlated with a higher risk of delayed treatment initiation and death within 30 days.
BACKGROUND: Despite a general consensus that rapid communication of critical radiology findings from radiologists to referring physicians is imperative, a possible association with superior patient outcomes has not been confirmed. The objective of this study was to evaluate the correlation between early direct communication of CT image findings by radiologists to referring physicians and better clinical outcomes in patients with acute pulmonary embolism (PE). METHODS: This was a retrospective, single-institution, cohort study that included 796 consecutive patients (February 2006 to March 2010) who had acute PE confirmed by CT pulmonary angiography (CTPA) and whose treatment had not been initiated at the time of CTPA acquisition. The time from CTPA to direct communication of the diagnosis was evaluated for its association with time from CTPA to treatment initiation and with 30-day mortality. Cox regression analysis was performed with inverse probability weighting by propensity scores calculated using 20 potential confounding factors. RESULTS: In 93.4% of patients whose first treatment was anticoagulation, the referring physicians started treatment after receiving direct notification of the diagnosis from the radiologist. Late communication (&gt; 1.5 h after CTPA; n = 291) was associated with longer time to treatment initiation (adjusted hazard ratio [HR], 0.714; 95% CI, 0.610-0.836; P &lt; .001) and higher all-cause and PE-related 30-day mortality (HR, 1.813; 95% CI, 1.163-2.828; P = .009; and HR, 2.625; 95% CI, 1.362-5.059; P = .004, respectively). CONCLUSIONS: Delay (&gt; 1.5 h of CTPA acquisition) in direct communication of acute PE diagnosis from radiologists to referring physicians was significantly correlated with a higher risk of delayed treatment initiation and death within 30 days.
Authors: Long Jiang Zhang; Guang Ming Lu; Felix G Meinel; Andrew D McQuiston; James G Ravenel; U Joseph Schoepf Journal: Eur Radiol Date: 2015-03-13 Impact factor: 5.315
Authors: Kanako K Kumamaru; Elizabeth George; Ayaz Aghayev; Sachin S Saboo; Ashish Khandelwal; Sara Rodríguez-López; Tianrun Cai; Daniel Jiménez-Carretero; Raúl San José Estépar; Maria J Ledesma-Carbayo; Germán González; Frank J Rybicki Journal: J Comput Assist Tomogr Date: 2016 May-Jun Impact factor: 1.826