Pulmonary embolism - Lung scanning interpretation: About words

Objective: To assess clinicians' agreement on how they interpret lung scan reports with regard to the diagnosis of pulmonary embolism. Design: In this prospective study, nuclear medicine physicians provided two types of reports for each lung scan: a routine descriptive report and a sh ort form with a standardized conclusion on the likelihood of pulmonary embo lism: "high probability," "no conclusion," and "diagnosis excluded," Three independent blinded senior clinicians reviewed all routine reports and chos e one of the following conclusions: "high probability," "no conclusion," or "diagnosis excluded." Setting: An acute care teaching hospital near Palls. Subjects: Eighty-two lung scans were studied. Main outcome measurements: Inter-clinician agreement and agreement between clinicians' conclusions and the nuclear medicine physicians' standardized r eports were analyzed using the kappa index. Results: The distribution of the clinicians' conclusions from routine repor ts strongly differed (p < 0.001). Agreement among the three clinicians was observed in 40.2% of the routine reports, and the inter-clinician agreement was poor to moderate (kappa range, 0.28 to 0.52). A complete agreement amo ng the three clinicians and the nuclear medicine physicians' standardized c onclusions was observed for 32.9% of the reports. The agreement between eac h clinician and the standardized conclusions was also poor to moderate (kap pa range, 0.32 to 0.55). Conclusion: Reading the same routine reports, clinicians reached different conclusions. Furthermore these differed greatly from the nuclear medicine p hysicians' standardized conclusions. These results support the notion that physicians should be given standardized reports.