title: Correlation between early direct communication of positive CT pulmonary angiography findings and improved clinical outcomes.
abstract: 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 (&gt; 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 &lt; .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 (&gt; 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.
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA.
authors.forename: Kanako K
authors.initials: KK
authors.lastname: Kumamaru
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA.
authors.forename: Andetta R
authors.initials: AR
authors.lastname: Hunsaker
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA.
authors.forename: Hiraku
authors.initials: H
authors.lastname: Kumamaru
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: George
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA.
authors.forename: Arash
authors.initials: A
authors.lastname: Bedayat
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA. Electronic address: frybicki@partners.org.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki
mesh_terms: D000208:Acute Disease; D000792:Angiography / Q000379:methods*; D019468:Disease Management; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011379:Prognosis; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000628:therapy; D012017:Referral and Consultation / Q000592:standards*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed