Quality of referrals for lower extremity ultrasonography and computed tomography pulmonary angiography and associations with positive findings of venous thromboembolism

S Naimi; K J Ødegaard; K K Jenssen; P M Lauritzen

doi:10.1016/j.radi.2024.03.002

Quality of referrals for lower extremity ultrasonography and computed tomography pulmonary angiography and associations with positive findings of venous thromboembolism

Radiography (Lond). 2024 May;30(3):799-805. doi: 10.1016/j.radi.2024.03.002. Epub 2024 Mar 16.

Authors

S Naimi¹, K J Ødegaard², K K Jenssen³, P M Lauritzen⁴

Affiliations

¹ Department of Life Sciences and Health, Oslo Metropolitan University, P.O. Box 4 St. Olavs Plass, NO-0130 Oslo, Norway. Electronic address: salmanai@oslomet.no.
² Department of Radiology, Lovisenberg Diaconal Hospital, Postboks 4970 Nydalen, NO-0440 Oslo, Norway. Electronic address: KajaJohannson.Odegaard@lds.no.
³ Department of Orthopedic Surgery, Lovisenberg Diaconal Hospital, Postboks 4970 Nydalen, NO-0440 Oslo, Norway. Electronic address: kjerstikaul.jenssen@lds.no.
⁴ Department of Life Sciences and Health, Oslo Metropolitan University, P.O. Box 4 St. Olavs Plass, NO-0130 Oslo, Norway; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Postboks 4956 Nydalen, NO-0424 Oslo, Norway. Electronic address: petermae@oslomet.no.

PMID: 38493553
DOI: 10.1016/j.radi.2024.03.002

Abstract

Introduction: The referral is the basis for radiologists' assessment of modality, protocol and urgency, and insufficient information may threaten patient safety. The aim of this study was to assess the completeness of referrals for lower extremity venous duplex ultrasonography (LEVDUS) and computed tomography pulmonary angiography (CTPA), and to investigate associations between the provided clinical information including risk factors, symptoms and lab results in the referrals and positive findings of deep vein thrombosis (DVT) and pulmonary embolism (PE), respectively.

Methods: Referrals for LEVDUS (801) and CTPA (800) performed from 2016 to 2019 were obtained. Three categories of clinical information from the referrals were recorded: symptoms, risk factors and laboratory results, as well as positive imaging findings of venous thromboembolism (VTE). Referral completeness was rated from zero to three according to how many categories of clinical information the referral provided.

Results: Information from all three clinical information categories was provided in 15% and 25% of referrals for LEVDUS and CTPA, respectively, while 2% and 10% of referrals did not contain any clinical information. Symptoms were provided most often (85% for LEVDUS and 94% for CTPA). Provided information about risk factors was significantly associated with positive findings for LEVDUS, (p = 0.02) and CTPA (p < 0.001).

Conclusion: A great majority of referrals failed to provide one or more categories of clinical information. Risk factors were associated with a positive finding of VTE on LEVDUS and CTPA.

Implications for practice: Improving clinical information in referrals may improve justification, patient safety and quality of radiology services.

Keywords: Clinical information; Computed tomography angiography; Health care quality; Referral; Ultrasonography; Venous thromboembolism.

MeSH terms

Adult
Aged
Computed Tomography Angiography* / methods
Female
Humans
Lower Extremity* / blood supply
Lower Extremity* / diagnostic imaging
Male
Middle Aged
Pulmonary Embolism / diagnostic imaging
Referral and Consultation*
Retrospective Studies
Risk Factors
Ultrasonography, Doppler, Duplex / methods
Venous Thromboembolism* / diagnostic imaging