Journal of the American College of Emergency Physicians Open (Oct 2022)

Synoptic reporting accuracy for computed tomography pulmonary arteriography among patients suspected of pulmonary embolism

  • Isabela A. Woller,
  • Scott C. Woller,
  • Scott M. Stevens,
  • James F. Lloyd,
  • Karen E. Conner,
  • Benjamin H. Gordon,
  • Greg L. Snow,
  • Peter Jones,
  • Joseph R. Bledsoe

DOI
https://doi.org/10.1002/emp2.12801
Journal volume & issue
Vol. 3, no. 5
pp. n/a – n/a

Abstract

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Abstract Background Structured reporting is an efficient and replicable method of presenting diagnostic results that eliminates variability inherent in narrative descriptive reporting and may improve clinical decisions. Synoptic element reporting can generate discrete coded data that then may inform clinical decision support and trigger downstream actions in computerized electronic health records. Objective Limited evidence exists for use of synoptic reporting for computed tomography pulmonary arteriography (CTPA) among patients suspected of pulmonary embolism. We reported the accuracy of synoptic reporting for the outcome of pulmonary embolism among patients who presented to an integrated health care system with CTPA performed for suspected pulmonary embolism. Methods Structured radiology reports with embedded synoptic elements were implemented for all CTPA examinations on March 1, 2018. Four hundred CTPA reports between January 4, 2019 and July 30, 2020 (200 reports each for which synoptic reporting recorded the presence or absence of pulmonary embolism [PE]) were selected at random. One non‐diagnostic study was excluded from analysis. We then assessed the accuracy of synoptic reporting compared with the gold standard of manual chart review. Results Synoptic reporting and manual review agreed in 99.2% of patients undergoing CTPA for suspected PE, agreed on the presence of PE in 196 of 199 (98.5%) cases, the absence of PE in 200 of 200 (100%) cases with a sensitivity of 87.6% (76.1–96.1) a specificity of 99.9% (99.7%–100%), a positive predictive value of 99.5% (98.1–100), and a negative predictive value of 98% (95.7%–99.5%). Conclusion The overall rate of agreement was 99.2%, but we observed an unacceptable false‐negative rate for clinical reliance on synoptic element reporting in isolation from dictated reports.

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