Critical Imaging Findings During Covid-19: Is There Consensus On Definitions And Handling?
Douglas L. Wooster, MD1, Elizabeth M. Wooster, M.Ed., PhD Candidate1, David M. Williams, MS2.
1Univ of Toronto, Toronto, ON, Canada, 2Medical Univ of South Carolina, Florence, SC, USA.
Objectives: This study addresses the following objectives: Is 1) there consensus regarding the definition and handling of critical imaging findings (CIF) in vascular ultrasound studies (VUS) appropriate to vascular COVID-19, 2) practice informed by accrediting bodies’ advice and published standards and guidelines (S+G)?
Methods: A literature review was done to define CIF of vascular complications of COVID-19 and to identify relevant S+G. This informed a 50-item survey that provided quantitative and qualitative responses related to definitions and handling of CIF. It was distributed to VUS experts All data was analyzed for common themes and outliers. The findings were mapped to vascular COVID-19 issues.
Results: 81/100 surveys were returned; 1012 data points and 101 text comments were identified. Identified CIF included deep or superficial venous thrombosis, symptomatic carotid stenosis or occlusion, new arterial findings and unusual findings. Concordance of definitions within domains was 32-96%; agreement with S+G was 58-89%; 59% used specific references to support their definitions. Practice gaps existed for SVT (7 - 60%), carotid stenosis with symptoms (17 - 58%), arterial disease (36%) and unusual findings (33%). Common themes included limited recognition of vascular COVID-19 and varying responses in handling CIF: classic ‘chain of medical responsibility’ (34%), technologist reporting (28%), timely report generation (11%), case-by-case system (5%) and ‘hold until care arranged’ (5%). 55 separate rationales were provided for handling CIF and 69% use variable protocols to deal with “a break in the critical findings process”.
Conclusions: The definitions and handling of CIF in VUS are variable across domains and within each domain; there is no consensus. There is no consistency with COVID-19 related vascular issues. Protocols for handling CIF are inconsistent and practice gaps exist.
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