Critical Findings: Timing of Notification in Neuroradiology

Honig, S.; Honig, Evan; Babiarz, Lukasz; Lewin, Jonathan S.; Berlanstein, Bruce; Yousem, David M.

doi:10.3174/ajnr.a3918

Cited by 15 publications

(6 citation statements)

References 8 publications

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“…First, a major limitation of our study is that prevalence data were pooled on the assumption that most included subjects had no more than one critical or indeterminate incidental finding. Second, there is no (inter)national consensus list of critical and indeterminate incidental findings . All extracted whole‐body MRI findings were reviewed by consensus of two radiologists based on the available information in the original studies.…”

Section: Discussionmentioning

confidence: 99%

“…Second, there is no (inter)national consensus list of critical and indeterminate incidental findings. 29,30 All extracted whole-body MRI findings were reviewed by consensus of two radiologists based on the available information in the original studies. Potentially relevant information such as subject's age and gender, and exact location, size, and signal characteristics of detected lesions were not presented for each subject.…”

Section: Discussionmentioning

confidence: 99%

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Whole‐body MRI for preventive health screening: A systematic review of the literature

Kwee

2019

Magnetic Resonance Imaging

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BackgroundThe yield of whole‐body MRI for preventive health screening is currently not completely clear.PurposeTo systematically review the prevalence of whole‐body MRI findings in asymptomatic subjects.Study TypeSystematic review and meta‐analysis.SubjectsMEDLINE and Embase were searched for original studies reporting whole‐body MRI findings in asymptomatic adults without known disease, syndrome, or genetic mutation. Twelve studies, comprising 5373 asymptomatic subjects, were included.Field Strength/Sequence1.5T or 3.0T, whole‐body MRI.AssessmentThe whole‐body MRI literature findings were extracted and reviewed by two radiologists in consensus for designation as either critical or indeterminate incidental finding.Statistical TestsData were pooled using a random effects model on the assumption that most subjects had ≤1 critical or indeterminate incidental finding. Heterogeneity was assessed by the I 2 statistic.ResultsPooled prevalences of critical and indeterminate incidental findings together and separately were 32.1% (95% confidence interval [CI]: 18.3%, 50.1%), 13.4% (95% CI: 9.0%, 19.5%), and 13.9% (95% CI: 5.4%, 31.3%), respectively. There was substantial between‐study heterogeneity (I 2 = 95.6–99.1). Pooled prevalence of critical and indeterminate incidental findings together was significantly higher in studies that included (cardio)vascular and/or colon MRI compared with studies that did not (49.7% [95% CI, 26.7%, 72.9%] vs. 23.0% [95% CI, 5.5%, 60.3%], P < 0.001). Pooled proportion of reported verified critical and indeterminate incidental findings was 12.6% (95% CI: 3.2%, 38.8%). Six studies reported false‐positive findings, yielding a pooled proportion of 16.0% (95% CI: 1.9%, 65.8%). None of the included studies reported long‐term (>5‐year) verification of negative findings. Only one study reported false‐negative findings, with a proportion of 2.0%.Data ConclusionPrevalence of critical and indeterminate incidental whole‐body MRI findings in asymptomatic subjects is overall substantial and with variability dependent to some degree on the protocol. Verification data are lacking. The proportion of false‐positive findings appears to be substantial. Level of Evidence: 4 Technical Efficacy: Stage 3J. Magn. Reson. Imaging 2019;50:1489–1503.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Whole‐body MRI for preventive health screening: A systematic review of the literature

Kwee

2019

Magnetic Resonance Imaging

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“…In this 2013 study, they surveyed the different relevant communication time points between radiologists and caregivers during an 8-week period [11]. The mean time from critical findings discovery to referring physician notification was 8.8 ± 6.9 minutes [11]. In our study, the average for the same parameter (IR time) for all patients was 9.13 ± 12.04 minutes.…”

Section: Resultsmentioning

confidence: 67%

“…Our data collected compared favorably with a study done by Honig et al, which assessed the timing of critical findings notification in neuroradiology. In this 2013 study, they surveyed the different relevant communication time points between radiologists and caregivers during an 8-week period [11]. The mean time from critical findings discovery to referring physician notification was 8.8 ± 6.9 minutes [11].…”

Section: Resultsmentioning

confidence: 99%

Critical Findings Reporting in Cranial CT Scans of Patients in a Tertiary Government Hospital Setting:A Pilot Study

Licaros¹,

Cañal²

2020

Acta Medica

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BACKGROUND AND PURPOSE: Effective communication among health care providers within an institution is vital for ensuring patient safety. A radiologist’s competence in identifying critical findings is just as important as being able to relay this information to the primary provider in a timely manner so that appropriate interventions can be initiated in life-threatening emergencies. This study aims to obtain baseline data regarding effective communication of critical findings between radiology and the primary health care providers. MATERIALS AND METHODS: Based on the Massachusetts’s Coalition for Prevention of Medical Errors safe practice recommendations, a communication protocol was developed. Certain selected cranial critical findings (new hemorrhage, new herniation, acute brain edema, acute stroke and findings suggestive of meningitis or abscess) were used in the critical findings protocol. Total communication time (TCT) in the relay of critical findings included time from CT scan order to scan (OS time), time from scan to interpretation (SI) and time from interpretation to relay (IR). All these times were recorded and compared to the standard 60 minutes using percent compliance, mean time, median time and standard deviation. RESULTS: Seventy-nine (79) critical findings were recorded and relayed in a 30-day period. There was 100% (79/79) compliance with the relay of critical findings to the primary care team and 97.5% (77/79) success rate in direct communication of critical findings within 60 minutes of identification. The mean OS time was 155.09 (±134.43) minutes, mean SI time was 46.54 (±44.01) minutes, and mean IR time was 9.13 (±12.04) minutes. The average time elapsed from CT study acquisition to direct notification was 57.0 (± 45.80) minutes. CONCLUSION: Effective communication of critical findings using a protocol adopted from set standards of safe practice recommendations is achievable in our institution. The proposed protocol exhibited compliance to and performed well against established benchmarks. The timely identification and delivery of critical findings to the primary care team is central to patient management and should be practiced in our setting. Keywords: critical finding, effective communication, cranial CT, standards

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“…A broad range of guidelines is available for the management of different types of incidental and critical findings [22][23][24][25][26][27]. In addition to recommendations on managing incidental findings, several reports have been published on whether these recommendations improve the communication of critical findings [21,[28][29][30][31][32], and on the level of adherence to guidelines. For example, Clark et al used free-text query software to identify studies investigating guideline adherence for two types of incidental findings (gallbladder polyps and thyroid nodules) [33].…”

Section: Comparison With the Literaturementioning

confidence: 99%

Contextual Structured Reporting in Radiology: Implementation and Long-Term Evaluation in Improving the Communication of Critical Findings

et al. 2020

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Structured reporting contributes to the completeness of radiology reports and improves quality. Both the content and the structure are essential for successful implementation of structured reporting. Contextual structured reporting is tailored to a specific scenario and can contain information retrieved from the context. Critical findings detected by imaging need urgent communication to the referring physician. According to guidelines, the occurrence of this communication should be documented in the radiology reports and should contain when, to whom and how was communicated. In free-text reporting, one or more of these required items might be omitted. We developed a contextual structured reporting template to ensure complete documentation of the communication of critical findings. The WHEN and HOW items were included automatically, and the insertion of the WHO-item was facilitated by the template. A pre-and post-implementation study demonstrated a substantial improvement in guideline adherence. The template usage improved in the long-term postimplementation study compared with the short-term results. The two most often occurring categories of critical findings are "infection / inflammation" and "oncology", corresponding to the a large part of urgency level 2 (to be reported within 6 h) and level 3 (to be reported within 6 days), respectively. We conclude that contextual structured reporting is feasible for required elements in radiology reporting and for automated insertion of context-dependent data. Contextual structured reporting improves guideline adherence for communication of critical findings.

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Critical Findings: Timing of Notification in Neuroradiology

Abstract: Direct communication with the responsible referring physician occurred consistently within 10-15 minutes after observation of a critical finding. These delays are less than the average interval from study acquisition to critical finding discovery (mean, 62.2 minutes).

Cited by 15 publications

References 8 publications

Whole‐body MRI for preventive health screening: A systematic review of the literature

Whole‐body MRI for preventive health screening: A systematic review of the literature

Critical Findings Reporting in Cranial CT Scans of Patients in a Tertiary Government Hospital Setting:A Pilot Study

Contextual Structured Reporting in Radiology: Implementation and Long-Term Evaluation in Improving the Communication of Critical Findings

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