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Outcomes of Incidental Lung Nodules With Structured Recommendations and Electronic Tracking.
- Source :
-
Journal of the American College of Radiology : JACR [J Am Coll Radiol] 2022 Mar; Vol. 19 (3), pp. 407-414. Date of Electronic Publication: 2021 Dec 08. - Publication Year :
- 2022
-
Abstract
- Objective: To evaluate the impact of structured recommendations on follow-up completion for incidental lung nodules (ILNs).<br />Methods: Patients with ILNs before and after implementation of structured Fleischner recommendations and electronic tracking were sampled randomly. The cohorts were compared for imaging follow-up. Multivariable logistic regression was used to assess appropriate follow-up and loss to follow-up, with independent variables including use of structured recommendations or tracking, age, sex, race, ethnicity, setting of the index test (inpatient, outpatient, emergency department), smoking history, and nodule features.<br />Results: In all, 1,301 patients met final inclusion criteria, including 255 patients before and 1,046 patients after structured recommendations or tracking. Baseline differences were found in the pre- and postintervention groups, with smaller ILNs and younger age after implementing structured recommendations. Comparing pre- versus postintervention outcomes, 40.0% (100 of 250) versus 29.5% (309 of 1,046) of patients had no follow-up despite Fleischner indications for imaging (P = .002), and among the remaining patients, 56.6% (82 of 145) versus 75.0% (553 of 737) followed up on time (P < .001). Delayed follow-up was more frequent before intervention. Differences postintervention were mostly accounted for by nodules ≤8 mm in the outpatient setting (P < .001). In multivariable analysis, younger age, White race, outpatient setting, and larger nodule size showed significant association with appropriate follow-up completion (P < .015), but structured recommendations did not. Similar results applied for loss to follow-up.<br />Discussion: Consistent use of structured reporting is likely key to mitigate selection bias when benchmarking rates of appropriate follow-up of ILN. Emergency department patients and inpatients are at high risk of missed or delayed follow-up despite structured recommendations.<br /> (Copyright © 2021 American College of Radiology. Published by Elsevier Inc. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 1558-349X
- Volume :
- 19
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Radiology : JACR
- Publication Type :
- Academic Journal
- Accession number :
- 34896068
- Full Text :
- https://doi.org/10.1016/j.jacr.2021.09.046