0
Original Research: Pulmonary Vascular Disease |

Correlation Between Early Direct Communication of Positive CT Pulmonary Angiography Findings and Improved Clinical OutcomesCommunication and Outcomes of Pulmonary Embolism

Kanako K. Kumamaru, MD, PhD; Andetta R. Hunsaker, MD; Hiraku Kumamaru, MD, MPH; Elizabeth George, MBBS; Arash Bedayat, MD; Frank J. Rybicki, MD, PhD
Author and Funding Information

From the Applied Imaging Science Laboratory, Department of Radiology (Drs K. Kumamaru, Hunsaker, George, Bedayat, and Rybicki), Brigham and Women’s Hospital & Harvard Medical School; and the Department of Epidemiology (Dr H. Kumamaru), Harvard School of Public Health, Boston, MA.

Correspondence to: Frank J. Rybicki, MD, PhD, Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital & Harvard Medical School, 75 Francis St, Boston, MA 02115; e-mail: frybicki@partners.org


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.


Chest. 2013;144(5):1546-1554. doi:10.1378/chest.13-0308
Text Size: A A A
Published online

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.

Figures in this Article

Sign In to Access Full Content

Want to Purchase a Subscription?

New to CHEST? Become an ACCP member to receive a full subscription to both the print and online editions.
Want to access your Institution's subscription?
Sign in to your individual user account while you are actively authenticated on this website via your institution (Learn more about institutional authentication). We will then sustain your personal access to their content/subscription for 90 days, after which you can repeat this process.

Sign In to Access Full Content

Want to Purchase a Subscription?

New to CHEST? Become an ACCP member to receive a full subscription to both the print and online editions.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543