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
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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.

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