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    Association Between Confidence Level of Acute Pulmonary Embolism Diagnosis on CTPA images and Clinical Outcomes

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    Authors
    Bedayat, Arash
    Sewatkar, Rani
    Cai, Tianrun
    George, Elizabeth
    Imanzadeh, Amir
    Hussain, Zoha
    Dunne, Ruth M.
    Hunsaker, Andetta R.
    Rybicki, Frank J.
    Kumamaru, Kanako K.
    UMass Chan Affiliations
    Department of Radiology
    Document Type
    Journal Article
    Publication Date
    2015-12-01
    Keywords
    CT
    Radiology reporting
    diagnostic confidence
    mortality
    pulmonary artery
    pulmonary embolism
    Radiology
    
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    Link to Full Text
    http://dx.doi.org/10.1016/j.acra.2015.08.018
    Abstract
    RATIONALE AND OBJECTIVES: The purpose was to evaluate clinical characteristics associated with low confidence in diagnosis of acute pulmonary embolism (PE) as expressed in computed tomography pulmonary angiography (CTPA) reports and to evaluate the effect of confidence level in PE diagnosis on patient clinical outcomes. MATERIALS AND METHODS: This study included radiology reports from 1664 consecutive CTPA considered positive for acute PE (8/2003-5/2010). All reports were retrospectively assessed for the level of confidence in diagnosis. Baseline characteristics and outcomes (therapies related to PE and short-term mortality) were compared between high and low confidence groups. Multivariable logistic and Cox regression analyses were used to analyze the relationship between the confidence level and outcomes. RESULTS: One-hundred sixty of 1664 (9.6%) reports had language that reflected a low confidence in PE diagnosis. The low confidence group had smaller (segmental and subsegmental) suspected emboli (prevalence, 72.5% vs. 50.7%; P < .001) and more comorbidities. The low confidence group had a lower likelihood of receiving PE-related therapies (adjusted odds ratio [OR], 0.18; 95% confidence interval, 0.10-031, P < .001), but there was no change in the all-cause and PE-related 30-day and/or 90-day mortality (OR of death for low confidence, 0.81-1.13, P values > .5). CONCLUSIONS: Roughly 10% of positive CTPA reports had uncertainty in PE findings, and patients with reports categorized as low confidence had smaller emboli and more comorbidities. Although the low confidence group was less likely to receive PE-related therapies, patients in this group were not associated with higher probability of short-term mortality.
    Source
    Acad Radiol. 2015 Dec;22(12):1555-61. doi: 10.1016/j.acra.2015.08.018. Epub 2015 Sep 26. Link to article on publisher's site
    DOI
    10.1016/j.acra.2015.08.018
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/48042
    PubMed ID
    26391859
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.acra.2015.08.018
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