title: Carotid artery stenosis: wide variability in reporting formats--a review of 127 Veterans Affairs medical centers.
abstract: OBJECTIVE
  To determine whether radiology reports describe clinically significant carotid arterial stenosis in a consistent format that is actionable by ordering clinicians.
  
  
  METHODS
  This study was HIPAA compliant. Informed consent was waived. Institutional review board approval was obtained for this retrospective chart review, which included radiology reports of carotid artery imaging for patients hospitalized with ischemic stroke at 127 Veterans Affairs medical centers in 2006-2007. "Clinically significant results" were defined as results with at least 50% stenosis or at least moderate stenosis, excluding complete occlusion. How often clinically significant results were reported as an exact percentage stenosis (such as 60%), range (such as 50%-69%), or category (such as moderate) was determined. Among results reported as a range, how often the range bracketed clinical thresholds of 50% and 70% (typically used to determine appropriateness of carotid arterial revascularization) was determined.
  
  
  RESULTS
  Among 2675 patients, there were 6618 carotid imaging results, of which 1015 (15%) were considered clinically significant. Among 695 clinically significant results at ultrasonography (US), 348 (50%) were described as a range, and another 314 (45%) were reported as an exact percentage stenosis. Among the 348 clinically significant US results reported as a range, 259 (74%) bracketed the thresholds of 50% or 70%. For magnetic resonance angiographic results, 48% (106 of 221) qualitatively described clinically significant results as a category, 38% (84 of 221) as an exact percentage stenosis, and 14% (31 of 221) as a range.
  
  
  CONCLUSIONS
  In this national health care system, the manner in which clinically significant carotid arterial stenosis was reported varied widely.
authors.affiliation: Department of Neurology, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, ML 127, Los Angeles, CA 90073, USA. eric.cheng@va.gov
authors.forename: Eric M
authors.initials: EM
authors.lastname: Cheng
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
authors.forename: Suzie
authors.initials: S
authors.lastname: El-Saden
authors.forename: Stefanie D
authors.initials: SD
authors.lastname: Vassar
authors.forename: Susan
authors.initials: S
authors.lastname: Ofner
authors.forename: Linda S
authors.initials: LS
authors.lastname: Williams
authors.forename: Salomeh
authors.initials: S
authors.lastname: Keyhani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000706:statistics & numerical data*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D005568:Forms and Records Control; D055991:Health Records, Personal; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology