Correlation between Early Direct Communication of Positive CT Pulmonary Angiography Findings and Improved Clinical Outcomes.
Chest. 2013 Jul 4;
Authors: Kumamaru KK, Hunsker AR, Kumamaru H, George E, Bedayat A, Rybicki FJ
ABSTRACT BACKGROUNDS: 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 findings by radiologists to referring physicians and better clinical outcomes in patients with acute pulmonary embolism (PE).
METHODS: Retrospective single-institution cohort study included 796 consecutive patients (February 2006-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. The late (>1.5 hours after CTPA, n=291) communication was associated with longer time to treatment initiation (adjusted Hazard Ratio (HR)=0.714, 95% Confidence Interval (CI): 0.610-0.836, p<0.001) and higher all-cause and PE-related 30-day mortality (HR=1.813, 95%CI: 1.163-2.828, p=0.009, and HR=2.625, 95% CI:1.362-5.059, p=0.004, respectively).
CONCLUSIONS: Delay (>1.5 hours 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.
PMID: 23828207 [PubMed - as supplied by publisher]