Chest
Original ResearchPulmonary Vascular DiseaseCorrelation Between Early Direct Communication of Positive CT Pulmonary Angiography Findings and Improved Clinical Outcomes
Section snippets
Study Population and CTPA Imaging
The Partners institutional review board (#2010P001277) approved this Health Insurance Portability and Accountability Act-compliant study; informed consent was waived. Among the 1,177 CTPA examinations that were performed at our academic institution from February 2006 to March 2010 and were positive for acute PE, 796 patients met the inclusion criteria (Fig 1).
CTPA studies were performed by 16-, 64-, or 128-slice multidetector CT scanners with a standard protocol after IV administration of 75 to
Clinical Characteristics
Patients in the early communication group (n = 505) had more severe PEs, indicated by the higher prevalence of central embolus and larger RV/LV diameter ratio (Table 1). Cancer, congestive heart failure, and chronic renal failure were more prevalent in the late communication group, and patients in this group were more likely to be admitted to the ICU. The CTPA studies in this group were more likely from the earlier years (2006–2007) compared with the early group.
The distribution of propensity
Discussion
Late (> 1.5 h from CTPA acquisition) communication of acute PE diagnosis from radiologists to referring physicians was significantly correlated with longer time to treatment initiation and higher 30-day mortality. Although we cannot draw conclusions on causality based solely on this observational study, our findings are, to our knowledge, the first evidence to support the general notion that earlier communication of imaging finding is beneficial to patient outcomes.
Although CTPA interpretation
Conclusions
Late (> 1.5 h from CTPA acquisition) communication of acute PE diagnosis had a higher risk of delayed treatment initiation and higher 30-day mortality. In this retrospective observational study, these associations lend support to a potential contribution of early direct communication of CT image findings to clinical outcomes, and warrant a confirmation in larger studies.
Acknowledgments
Author contributions: Dr K. Kumamaru had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr K. Kumamaru: contributed to study concept and design; data acquisition, analysis, and interpretation; drafting the manuscript; approval of the final manuscript; administrative, technical, or material support; and study supervision and served as principal author.
Dr Hunsaker: contributed to study concept and design;
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Cited by (19)
Clinical Impact of a Radiologic Quality Initiative Promoting More Timely Communication of Critical Pulmonary Embolus Results
2020, Academic RadiologyCitation Excerpt :Delays and failures to communicate critical results are common occurrences that pose threats to patient safety (13). A 2013 study by Kumamaru et al. demonstrated that a delay in direct communications 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 (14). Quality initiatives have been shown to improve communication of critical results (15) and may be of particular benefit when applied toward the management of PE.
CT pulmonary angiography-based scoring system to predict the prognosis of acute pulmonary embolism
2016, Journal of Cardiovascular Computed TomographyCitation Excerpt :Another strength of the CTPA-based model is that physicians can calculate the score using the CT images alone, and do not need to retrieve information from the patient's electronic medical record (e.g., laboratory results and echocardiography). The CTPA-based scores can be calculated by radiologists, which may help referring physicians make immediate management decisions, in addition to prompt communication of the diagnosis of PE, which should improve the patient's outcome.20 There are several CT findings related to RV dysfunction, and the RV/LV diameter ratio has been intensively evaluated for predicting the prognosis of acute PE.6,8,9,11
Timing of pulmonary embolism diagnosis in the emergency department
2016, Thrombosis ResearchCitation Excerpt :Therefore, we assume that no relevant delay emerged in this step in the present study. The influence of the time to diagnosis on survival in patients with PE has been studied in a number of reports [1,6,8,23]. As early as 2002 a Japanese study found that mortality was significantly lower in the < 24 h TTD group [8].
Dr Bedayat is currently at the Department of Radiology, University of Massachusetts Medical School, Worcester, MA.
Part of this paper was presented at the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America, on November 27-December 2, 2011, Chicago, IL.
Funding/Support: Dr K. Kumamaru was supported by The Japan Society for the Promotion of Science, as a Postdoctoral Fellow for Research Abroad, to conduct this study.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.