title: What's in a Name? Factors Associated with Documentation and Evaluation of Incidental Pulmonary Nodules.
abstract: Radiologist reports of pulmonary nodules discovered incidentally on computed tomographic (CT) images of the chest may influence subsequent evaluation and management.
  
  
  
  We sought to determine the impact of the terminology used by radiologists to report incidental pulmonary nodules on subsequent documentation and evaluation of the nodules by the ordering or primary care provider.
  
  
  
  We conducted a retrospective cohort study of patients with incidentally discovered pulmonary nodules detected on CT chest examinations performed during 2010 in a large urban safety net medical system located in northeastern Ohio.
  
  
  
  Twelve different terms were used to describe 344 incidental pulmonary nodules. Most nodules (181 [53%]) were documented in a subsequent progress note by the provider, and 140 (41%) triggered subsequent clinical activity. In a multivariable analysis, incidental pulmonary nodules described in radiology reports using the terms density (odds ratio [OR], 0.06; 95% confidence interval [CI], 0.01-0.47), granuloma (OR, 0.07; 95% CI, 0.01-0.65), or opacity (OR, 0.09; 95% CI, 0.01-0.68) were less likely to be documented by the provider than those that used the term mass. Patients with nodules described in radiology reports using the term nodule (OR, 0.15; 95% CI, 0.02-0.99), nodular density (OR, 0.09; 95% CI, 0.01-0.63), granuloma (OR, 0.06; 95% CI, 0.01-0.69), or opacity (OR, 0.05; 95% CI, 0.01-0.43) were less likely to receive follow-up than were patients with nodules described using the term mass. The factor most strongly associated with follow-up of pulmonary nodules was documentation by the provider (OR, 5.85; 95% CI, 2.93-11.7).
  
  
  
  Within one multifacility urban health system in the United States, the terms used by radiologists to describe incidental pulmonary nodules were associated with documentation of the nodule by the ordering physician and subsequent follow-up. Standard terminology should be used to describe pulmonary nodules to improve patient outcomes.
authors: 1 Division of Pulmonary, Critical Care, and Sleep Medicine.|2 Department of Internal Medicine.
authors: Muhammad Nouman
authors: MN
authors: Iqbal
authors: 3 School of Medicine and.
authors: Emily
authors: E
authors: Stott
authors: 2 Department of Internal Medicine.|5 Center for Reducing Health Disparities, and.|4 Division of Nephrology, University Hospitals, Cleveland, Ohio.
authors: Anne M
authors: AM
authors: Huml
authors: 1 Division of Pulmonary, Critical Care, and Sleep Medicine.|2 Department of Internal Medicine.
authors: Vidya
authors: V
authors: Krishnan
authors: 2 Department of Internal Medicine.
authors: Ciaran Joseph
authors: CJ
authors: Scallan
authors: 2 Department of Internal Medicine.
authors: Jawid
authors: J
authors: Darvesh
authors: 2 Department of Internal Medicine.
authors: Karthik
authors: K
authors: Kode
authors: 2 Department of Internal Medicine.
authors: Chloe
authors: C
authors: Castro
authors: 2 Department of Internal Medicine.
authors: Naveen
authors: N
authors: Turlapati
authors: 6 Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; and.
authors: Clare
authors: C
authors: Landefeld
authors: 5 Center for Reducing Health Disparities, and.
authors: Julie
authors: J
authors: Pencak
authors: 5 Center for Reducing Health Disparities, and.
authors: Maria
authors: M
authors: Cedeño
authors: 7 Department of Radiology, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio.
authors: William
authors: W
authors: Baughman
authors: 5 Center for Reducing Health Disparities, and.
authors: Catherine
authors: C
authors: Sullivan
authors: 1 Division of Pulmonary, Critical Care, and Sleep Medicine.|2 Department of Internal Medicine.|5 Center for Reducing Health Disparities, and.
authors: J Daryl
authors: 0000-0002-1356-0280
authors: JD
authors: Thornton
mesh_terms: D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making; D004282:Documentation / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D033162:Incidental Findings; D016015:Logistic Models; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging*; D015999:Multivariate Analysis; D009820:Ohio; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
keywords: CT scan; clinical decision making; multiple pulmonary nodules; solitary pulmonary nodule