Zaree Omar A, Nguyen Jeffers K, Dixe de Oliveira Santo Irene, Kertam Ahmed E, Rahmani Saeed, Johnson Jason, Tu Long H
From the Tu Lab for Diagnostic Research (O.A.Z., A.E.K., S.R., L.H.T.), Yale School of Medicine, New Haven, Connecticut.
Department of Radiology and Biomedical Imaging (J.K.N., I.D.d.O.S., J.J. L.H.T.), Yale School of Medicine, New Haven, Connecticut.
AJNR Am J Neuroradiol. 2025 Aug 1;46(8):1670-1676. doi: 10.3174/ajnr.A8660.
Timely reporting of CTA examinations impacts management of acute vascular pathology such as large vessel occlusions, arterial dissection, and ruptured aneurysms, as well as a variety of acute nonvascular pathologies. In this study, we examine potential modifiable factors impacting the timeliness of CTA reporting performed in stroke code activations.
This is an observational study of stroke code CTA head and neck examinations performed at a single health system (3 emergency departments, 1550 inpatient beds) during 4 years (January 1, 2019, to December 31, 2023). Patient age, patient sex, care setting, time of year, shift type, trainee/attending radiologist characteristics, report factors, and number of CTAs performed within the preceding hour were considered potential factors impacting the turnaround time (TAT) of stroke code CTAs. Descriptive statistics, univariate regression, and multivariate regression were used to estimate the impact on reporting TAT.
We performed 8422 stroke code CTA examinations. Median TAT was 29 minutes (interquartile range [IQR] 18-48). Median TAT by individual attending radiologists varied from 15 to 40 minutes (median of medians, 29 minutes [IQR 26-34.5]). Univariate regression analyses found younger patient age, emergency department setting, time later in the academic year, nonbusiness hours, specific individual radiologists/trainees, solo reporting by attending radiologists, use of preliminary reports, and fewer stroke codes within the preceding hour to all be associated with shorter TATs (all < .05). After adjusting for patient-, logistical-, and radiologist-level factors in a multivariate regression model, the greatest impact on TAT was seen with variation in individual attending radiologists (adjusted coefficients, -11.9 to +29.4 minutes) and trainees (-40.1 to +95.7 minutes); reporting CTAs without a trainee and release of preliminary reports before final sign were associated with faster TATs (-19.9 and -26.9 minutes, respectively). Each stroke CTA within the preceding hour was associated with only a 2.8-minute increase in TAT. Secondary analyses suggested that previewing of cases during active scanning and use of "structured" reports correlate with a favorable impact on TAT among attending radiologists (both < .05).
Radiologist and trainee-level timeliness in stroke CTA reporting varies widely. Interventions aimed at improving workflow efficiency for both trainees and attending radiologists could improve timeliness of reporting.
及时报告CTA检查结果会影响急性血管病变（如大血管闭塞、动脉夹层和动脉瘤破裂）以及多种急性非血管病变的管理。在本研究中，我们探讨了影响中风代码激活时CTA报告及时性的潜在可改变因素。
这是一项对某单一医疗系统（3个急诊科，1550张住院床位）在4年期间（2019年1月1日至2023年12月31日）进行的中风代码CTA头颈部检查的观察性研究。患者年龄、患者性别、护理环境、一年中的时间、班次类型、实习医生/主治放射科医生特征、报告因素以及前一小时内进行的CTA数量被视为影响中风代码CTA检查周转时间（TAT）的潜在因素。使用描述性统计、单变量回归和多变量回归来估计对报告TAT的影响。
我们进行了8422次中风代码CTA检查。中位TAT为29分钟（四分位间距[IQR]为18 - 48分钟）。各主治放射科医生的中位TAT在15至40分钟之间（中位数的中位数为29分钟[IQR 26 - 34.5分钟]）。单变量回归分析发现，患者年龄较小、急诊科环境、学年后期、非工作时间、特定的个别放射科医生/实习医生、主治放射科医生单独报告、使用初步报告以及前一小时内中风代码较少均与较短的TAT相关（均P < 0.05）。在多变量回归模型中对患者、后勤和放射科医生层面的因素进行调整后，对TAT影响最大的是个别主治放射科医生（调整系数为 - 11.9至 + 29.4分钟）和实习医生（ - 40.1至 + 95.7分钟）的差异；没有实习医生参与报告CTA以及在最终签字前发布初步报告与更快的TAT相关（分别为 - 19.9和 - 26.9分钟）。前一小时内每增加一次中风CTA检查，TAT仅增加2.8分钟。二次分析表明，在扫描过程中预览病例以及使用“结构化”报告与主治放射科医生的TAT受到有利影响相关（均P < 0.05）。
中风CTA报告中放射科医生和实习医生层面的及时性差异很大。旨在提高实习医生和主治放射科医生工作流程效率的干预措施可能会提高报告的及时性。
