The identification and reporting of critical findings (CF) in vascular ultrasound studies (VUS) is important to timely and appropriate management of patients. There are published standards for the handling of such urgent situations; there are clinical practice guidelines (CPG) that can inform identifying CF. This study was designed to address the following questions: Is there consensus on the definition of CF and is practice informed by CPG?
A literature survey was conducted of standards and guidelines relevant to CF in VUS. A survey addressed CF in VUS; 50 question items addressed the definition of a CF. The survey was distributed to a sample of VUS champions including technologists and reporting physicians. Quantitative methods and qualitative text parsing identified common themes and outliers.
81 surveys were returned; 1012 data points and 101 text comments were identified for this analysis. 94% were accredited facilities. Specific domains of CF included deep venous thrombosis, superficial venous thrombosis, carotid stenosis with symptoms, new findings of aortic aneurysm, arteriovenous fistula, false aneurysm, aortic dissection, graft occlusion and unusual findings. Detailed assay of venous thrombosis, carotid stenosis and aortic aneurysm identified if ‘all’, ‘selected’ or ‘none’ were considered in the definitions. Concordance of definitions within the survey was 32 to 96%; agreement with published CPG ranged from 58 to 89%. Only 59% used specific references to support their definitions of CF. A gap compared to CPG existed for SVT (high risk features 7 – 60%), carotid stenosis with symptoms (17 – 58%), AAA (> 5.5cm (67%) or rapid expansion (36%)) and unusual findings (33%).
The definition of a CF on VUS is variable across domains and within each domain; there is no consensus. The definitions identified are not consistent with CPG and high-risk characteristics within domains do not reflect CPG.
Douglas Wooster, Professor of Surgery, University of Toronto