Maehara Cleo K, Silverman Stuart G, Lacson Ronilda, Khorasani Ramin
1 Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
AJR Am J Roentgenol. 2014 Oct;203(4):828-34. doi: 10.2214/AJR.13.11497.
The purpose of this study was to assess radiologists' adherence to published guidelines for managing renal masses detected at abdominal CT at one institution and to a critical results communication policy.
A validated natural language processing tool supplemented by manual review was used to randomly assemble a cohort of 97 radiology reports from all abdominal CT reports (n = 11,952) generated from July 2010 to June 2011. Critical renal mass findings warranted consideration for surgery, intervention, or imaging follow-up and required direct, separate, and timely communication to the referrer in addition to the radiology report. Primary outcomes were adherence to guidelines and institutional policy for communicating critical results. Sample size allowed a 95% CI ± 5% for primary outcome. Pearson chi-square test was performed to assess whether radiology subspecialization was predictive of the primary outcome.
Of all abdominal CT reports, 35.6% contained at least one renal mass finding (4.3% critical). Guideline adherence was lower for patients with critical than for those with noncritical findings (48/57 [84.2%] vs 40/40 [100%]; p = 0.01). Adherence to critical result communication policy was 73.7% (42/57). For critical findings, abdominal radiologists had higher guideline adherence (40/43 [93.0%] vs 8/14 [57.1%]; p = 0.001) and critical result communication policy adherence (36/43 [83.7%] vs 6/14 [42.9%]; p = 0.002) than nonabdominal radiologists.
In reporting renal masses detected at abdominal CT, radiologists largely adhered to management guidelines but did not adhere to the critical results communication policy in one of four reports. Subspecialization improved adherence to both management guidelines and the institution's critical result communication policy.
本研究旨在评估一家机构的放射科医生对已发表的腹部CT检查中发现肾肿块的管理指南以及关键结果沟通政策的遵循情况。
使用经过验证的自然语言处理工具并辅以人工审核,从2010年7月至2011年6月生成的所有腹部CT报告(n = 11,952)中随机抽取97份放射学报告组成队列。关键肾肿块发现需要考虑手术、干预或影像随访,除放射学报告外,还需要直接、单独且及时地与转诊医生沟通。主要结果是对指南和传达关键结果的机构政策的遵循情况。样本量允许主要结果的95%置信区间为±5%。进行Pearson卡方检验以评估放射学亚专业是否可预测主要结果。
在所有腹部CT报告中,35.6%至少包含一项肾肿块发现(4.3%为关键发现)。关键发现患者的指南遵循率低于非关键发现患者(48/57 [84.2%]对40/40 [100%];p = 0.01)。对关键结果沟通政策的遵循率为73.7%(42/57)。对于关键发现,腹部放射科医生的指南遵循率(40/43 [93.0%]对8/14 [57.1%];p = 0.001)和关键结果沟通政策遵循率(36/43 [83.7%]对6/14 [42.9%];p = 0.002)高于非腹部放射科医生。
在报告腹部CT检查中发现的肾肿块时,放射科医生在很大程度上遵循了管理指南,但四份报告中有一份未遵循关键结果沟通政策。亚专业提高了对管理指南和机构关键结果沟通政策的遵循率。