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2009 HSR&D National Meeting Abstract

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National Meeting 2009

3017 — Missed Incidental Abdominal Aortic Dilations Detected on CT Scanning in the VA

Gordon JR (Iowa City VA), Wahls T (Iowa City VA), Carolos RC (Ann Arbor VA), Pipinos II (Omaha VA), Cram P (Iowa City VA)

Objectives:
To examine the frequency and causes of missed incidental dilations of the abdominal aorta detected on computed tomography (CT) scans.

Methods:
We reviewed consecutive radiology reports for CT scans performed at two Midwestern VA Medical Centers during 2003 and identified all patients with dilations of the abdominal aorta. Each dilation was categorized as incidental (i.e., the dilation was not suspected at the time of the CT scan) or non-incidental. For patients with incidental dilations, we abstracted both the radiology report and electronic medical record (EMR) to collect the following data: 1) patient demographics and size of the dilation, 2) the terminology used by the radiologist to describe the dilation, 3) whether radiologists notified the clinical service of the dilation, and 4) the amount of time that elapsed between the initial CT scan and recognition of the dilation by the clinical team.

Results:
We reviewed CT scans of 4,112 patients and identified 440 (11%) with aortic dilation, of which 80 (18%) were deemed incidental. Mean age of patients with incidental dilations was 72.3 years and 100% were male. Mean size of the dilations was 3.7 cm. Abnormalities were described by radiologists using the following terms: “dilation” (29% of abnormalities), “aneurysm” (24%), “aneurysmal” (23%), “ectasia” (20%), and a variety of other terms (25%). Radiologists directly contacted clinical teams for 4% (3 out of 72) of abnormalities < 5.5 cm in size and 0% (0 out of 8) that were > 5.5 cm (P = .93). Clinical teams did not recognize 64% (51 of 80) abnormalities within three months of the index CT scan, and 10% of these abnormalities were 5.5 cm or larger. While 43% of abnormalities were recognized at an average of 2.3 years after the initial scan, 6 (12%) were not recognized during mean follow up of 3.2 years. Kappa scores for all key elements were > 0.80.

Implications:
Incidental aortic dilations were often missed despite an advanced EMR that makes results widely available and accessible to clinical teams.

Impacts:
Better systems are needed to insure that important abnormal test results are reviewed and appropriate follow-up is initiated.


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