Renal Masses Detected at Abdominal CT: Radiologists' Adherence to Guidelines Regarding Management Recommendations and Communication of Critical Results
Renal Masses Detected at Abdominal CT: Radiologists' Adherence to Guidelines Regarding Management Recommendations and Communication of Critical Results
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DOI：
10.2214/ajr.13.11497
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发表时间：
2014-10-01
影响因子：
5
通讯作者：
Khorasani, Ramin
中科院分区：
文献类型：
--
作者：
Maehara, Cleo K.;Silverman, Stuart G.;Khorasani, Ramin
客观的。本研究的目的是评估放射科医生对已发布的管理在一个机构腹部 CT 检测到的肾脏肿块的指南以及关键结果沟通政策的遵守情况。材料和方法。使用经过验证的自然语言处理工具辅以人工审核，从 2010 年 7 月至 2011 年 6 月生成的所有腹部 CT 报告 (n = 11,952) 中随机收集了 97 份放射学报告。关键的肾脏肿块发现需要考虑手术、干预或影像随访，除了放射学报告外，还需要与转诊者进行直接、单独和及时的沟通。主要结果是遵守传达关键结果的指南和机构政策。主要结果的样本量允许 95% CI +/- 5%。进行皮尔逊卡方检验以评估放射学亚专业化是否可以预测主要结果。结果。在所有腹部 CT 报告中，35.6% 包含至少一处肾脏肿块发现（4.3% 严重）。危重患者的指南依从性低于非危重患者（48/57 [84.2%] vs 40/40 [100%]；p = 0.01）。遵守关键结果沟通政策的率为 73.7% (42/57)。对于关键发现，腹部放射科医生比非腹部放射科医生具有更高的指南遵守率（40/43 [93.0%] vs 8/14 [57.1%]；p = 0.001）和关键结果沟通政策遵守率（36/43 [83.7%] vs 6/14 [42.9%]；p = 0.002）。结论。在报告腹部 CT 检测到的肾脏肿块时，放射科医生基本上遵守了管理指南，但没有遵守四份报告之一中的关键结果沟通政策。子专业化提高了对管理指南和机构关键结果沟通政策的遵守。
OBJECTIVE. The purpose of this study was to assess radiologists' adherence to published guidelines for managing renal masses detected at abdominal CT at one institution and to a critical results communication policy.MATERIALS AND METHODS. A validated natural language processing tool supplemented by manual review was used to randomly assemble a cohort of 97 radiology reports from all abdominal CT reports (n = 11,952) generated from July 2010 to June 2011. Critical renal mass findings warranted consideration for surgery, intervention, or imaging follow-up and required direct, separate, and timely communication to the referrer in addition to the radiology report. Primary outcomes were adherence to guidelines and institutional policy for communicating critical results. Sample size allowed a 95% CI +/- 5% for primary outcome. Pearson chi-square test was performed to assess whether radiology subspecialization was predictive of the primary outcome.RESULTS. Of all abdominal CT reports, 35.6% contained at least one renal mass finding (4.3% critical). Guideline adherence was lower for patients with critical than for those with noncritical findings (48/57 [84.2%] vs 40/40 [100%]; p = 0.01). Adherence to critical result communication policy was 73.7% (42/57). For critical findings, abdominal radiologists had higher guideline adherence (40/43 [93.0%] vs 8/14 [57.1%]; p = 0.001) and critical result communication policy adherence (36/43 [83.7%] vs 6/14 [42.9%]; p = 0.002) than non-abdominal radiologists.CONCLUSION. In reporting renal masses detected at abdominal CT, radiologists largely adhered to management guidelines but did not adhere to the critical results communication policy in one of four reports. Subspecialization improved adherence to both management guidelines and the institution's critical result communication policy.