Chest
Volume 144, Issue 5, November 2013, Pages 1546-1554
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Original Research
Pulmonary Vascular Disease
Correlation Between Early Direct Communication of Positive CT Pulmonary Angiography Findings and Improved Clinical Outcomes

https://doi.org/10.1378/chest.13-0308Get rights and content

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.

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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    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.

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