title: Association Between Confidence Level of Acute Pulmonary Embolism Diagnosis on CTPA images and Clinical Outcomes.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, 75 Francis St, Boston MA 02115; Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts.
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, 75 Francis St, Boston MA 02115.
authors.forename: Rani
authors.initials: R
authors.lastname: Sewatkar
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, 75 Francis St, Boston MA 02115.
authors.forename: Tianrun
authors.initials: T
authors.lastname: Cai
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, 75 Francis St, Boston MA 02115.
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, 75 Francis St, Boston MA 02115.
authors.forename: Amir
authors.initials: A
authors.lastname: Imanzadeh
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, 75 Francis St, Boston MA 02115.
authors.forename: Zoha
authors.initials: Z
authors.lastname: Hussain
authors.affiliation: Department of Radiology, Thoracic Imaging, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Dunne
authors.affiliation: Department of Radiology, Thoracic Imaging, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts.
authors.forename: Andetta R
authors.initials: AR
authors.lastname: Hunsaker
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, 75 Francis St, Boston MA 02115; Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, 75 Francis St, Boston MA 02115; Department of Radiology, Juntendo University, Tokyo, Japan. Electronic address: k-kumamaru@juntendo.ac.jp.
authors.forename: Kanako K
authors.initials: KK
authors.lastname: Kumamaru
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D035501:Uncertainty
keywords: CT; Radiology reporting; diagnostic confidence; mortality; pulmonary artery; pulmonary embolism