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RATIONALE: Radiologist reports of pulmonary nodules discovered incidentally on computed tomographic (CT) images of the chest may influence subsequent evaluation and management. OBJECTIVES: We sought to determine the impact of the terminology used by radiologists to report incidental pulmonary nodules on subsequent documentation and evaluation of the nodules by the ordering or primary care provider. METHODS: We conducted a retrospective cohort study of patients with incidentally discovered pulmonary nodules detected on CT chest examinations performed during 2010 in a large urban safety net medical system located in northeastern Ohio. MEASUREMENTS AND MAIN RESULTS: Twelve different terms were used to describe 344 incidental pulmonary nodules. Most nodules (181 [53%]) were documented in a subsequent progress note by the provider, and 140 (41%) triggered subsequent clinical activity. In a multivariable analysis, incidental pulmonary nodules described in radiology reports using the terms density (odds ratio [OR], 0.06; 95% confidence interval [CI], 0.01-0.47), granuloma (OR, 0.07; 95% CI, 0.01-0.65), or opacity (OR, 0.09; 95% CI, 0.01-0.68) were less likely to be documented by the provider than those that used the term mass. Patients with nodules described in radiology reports using the term nodule (OR, 0.15; 95% CI, 0.02-0.99), nodular density (OR, 0.09; 95% CI, 0.01-0.63), granuloma (OR, 0.06; 95% CI, 0.01-0.69), or opacity (OR, 0.05; 95% CI, 0.01-0.43) were less likely to receive follow-up than were patients with nodules described using the term mass. The factor most strongly associated with follow-up of pulmonary nodules was documentation by the provider (OR, 5.85; 95% CI, 2.93-11.7). CONCLUSIONS: Within one multifacility urban health system in the United States, the terms used by radiologists to describe incidental pulmonary nodules were associated with documentation of the nodule by the ordering physician and subsequent follow-up. Standard terminology should be used to describe pulmonary nodules to improve patient outcomes.

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BACKGROUND: Patients with low glomerular filtration rate (GFR) are at risk for hemorrhagic stroke and experience poor long-term outcomes after stroke. These associations may be mediated by hematoma volume. We investigated the relationship between impaired renal function (GFR <60 mL/min/1.73 m(2)) and hematoma size. METHODS: Consecutive patients admitted with spontaneous intracerebral hemorrhage (sICH) between August 2006 and January 2010 were evaluated; patients with acute kidney injury or end stage renal disease were excluded. Data on patient demographics, admission creatinine, size and location of bleed, and disposition at discharge were collected. Hematoma size and location and discharge outcomes were compared among those with normal and impaired renal function. RESULTS: Among 573 patients admitted with sICH, 411 met our study criteria (mean age 61.4 years; 52.3% female; median ICH volume 11.2 mL). Mean GFR was 73.8 mL/min/1.73 m(2), and 99 patients (24.1%) had a GFR <60 mL/min/1.73 m(2). There was no correlation between admission GFR and ICH volume (rs = 0.014; P = .77); those with GFR <60 versus ≥60 mL/min/1.73 m(2) also had similar ICH volumes (median 10.8 v 11.4 mL; P = .54). There was no association between in-hospital mortality and admission GFR, although those with GFR <60 mL/min/1.73 m(2) were more likely to die or be discharged to nursing homes (adjusted odds ratio 1.9; P = .03). CONCLUSIONS: In a large sICH cohort, impaired renal function was not associated with final hematoma volume. Additional study should focus on the mechanism by which renal function impacts functional outcomes after sICH.

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