Elsevier

Clinical Radiology

Volume 65, Issue 8, August 2010, Pages 616-622
Clinical Radiology

Original Paper
Provisional reporting of polytrauma CT by on-call radiology registrars. Is it Safe?

https://doi.org/10.1016/j.crad.2010.04.010Get rights and content

Aim

To assess the accuracy of provisional reporting and the impact on patient management.

Materials and methods

Over a 6 month period, 137 polytrauma computed tomography (CT) examinations were performed by on-call registrar radiologists at our institution. After exclusions, 130 cases were analysed. Discrepancies between registrar and consultant reports were reviewed and classified as either major or minor dependent on potential impact on patient safety. The relationship between seniority of reporting registrar and likelihood of a missed finding was analysed using the Chi-square test.

Results

Of the 130 patients, 46 (35%) had a serious injury, 36 (28%) a minor injury, and 48 (38%) no identifiable injury on CT. There were 32 (25%) patients with discrepancies of which 24 (18%) had missed or significantly under-reported findings and eight (6%) overcalled findings. There were six misses classified as major; the remaining 18 were classified as minor. No association was found between the seniority of reporting registrar and the likelihood of a miss (p = 0.96).

Conclusion

The incidence of major discrepancies between the provisional and final report was low and did not lead to any significant clinical deterioration. Our study provides a reference of the commonly missed injuries. We conclude that registrar provisional reporting of polytrauma is safe; however, note that a large proportion of examinations are normal and that further work is required to produce robust criteria given the radiation risk to a young population group scanned in trauma.

Introduction

Polytrauma computed tomography (CT), which involves imaging the head, spine, thorax, abdomen, and pelvis, has been shown to have a positive effect on patient outcome reducing mortality by between 13 to 25%.1 This, in part, reflects the reduction in deaths from exsanguination by the accurate and early detection of haemorrhage.2 The increased use of trauma CT has significantly improved the speed and accuracy of diagnosis in the emergency setting when compared with traditional methods of radiological diagnosis that were largely based on the interpretation of plain films.3, 4, 5 Previously established techniques in trauma management, such as peritoneal lavage for the identification of significant intra-abdominal haemorrhage have been largely replaced by CT.6 CT has advantages over ultrasound for the diagnosis of solid organ injury, demonstrating a high detection accuracy for liver and splenic trauma (up to 98%).7 By using predictors, such as active contrast extravasation, CT can help determine which patients will benefit from immediate intervention and which can be managed conservatively.7 Missed injuries in trauma reporting can be problematic and result in an increased morbidity and mortality.8, 9 Double-reporting of trauma CT has been shown to improve diagnostic accuracy.10

Polytrauma CT examinations place particular demands on the reporting radiologist. The studies are complex and typically cover a number of subspecialty areas of radiology. A radiological opinion must be generated in as short a time as possible, which can mean the radiologist has to alter his or her usual reporting methods. Pressure on the radiologist by the subspecialty clinical firms, who are often only interested in one particular anatomical area, adds to the degree of difficulty. In order to provide the referring clinicians with concise and easy to understand provisional reports, we recently introduced a reporting proforma for trauma CT. This takes the form of a tabulated list divided by anatomical area with a final summary. The aim was to replace traditional reports that were often lengthy pieces of prose that made it difficult for each subspecialty clinical firm to extract the key information pertinent to their area of interest. The system-based layout was also designed to act as an aide memoir for the reporting registrar to ensure all areas were appropriately reviewed before the provisional report was produced.

The aim of this study was to review the performance of on-call radiology registrars reporting polytrauma CT by comparing the accuracy of their report with that of a specialist consultant radiologist. The discrepancies were analysed with respect to their potential impact on emergency management. Registrars were also grouped according to experience and the performance between the groups was compared.

Section snippets

Study group

The study is a retrospective review of present practice and formal ethics committee approval is not necessary within our trust. Data were collected consecutively over a 6 month period between April and October 2008. Only examinations performed during on-call periods were considered for analysis. During this period there were 137 polytrauma CT examinations performed on-call at our institution, which is the regional trauma centre. Cases reported directly by consultant radiologists were excluded (n

Results

Of the 130 patients included in the study the age range was 13–92 years with a lower quartile of 22 years, median of 32 years, and upper quartile of 53 years. The male to female ratio was 3:1. The most common mechanism of injury was a road traffic accident (RTA) accounting for 87 cases (67%) of which 20 were pedestrians. Clinically severe injuries were found in 46 (35%) patients as defined by requiring hospital admission for greater than 72 h, requiring operative intervention, or resulting in

Discussion

The accurate and timely reporting of polytrauma CT is pivotal for the emergency management of patients with often serious injuries affecting a number of body areas. Although the present study revealed discrepancies between the registrar provisional reports and the formal consultant radiologist reports, the incidence was low and did not lead to any adverse clinical events. In most instances, the misses were minor and occurred in the setting of correctly reported major injuries elsewhere.

Based on

Acknowledgements

The authors thank Dominic Barron and Jeremy Macmullen-Price.

References (20)

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