Original PaperProvisional reporting of polytrauma CT by on-call radiology registrars. Is it Safe?
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)
- et al.
Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multi-centre study
Lancet
(2009) - et al.
Patterns of mortality and causes of death in polytrauma patients—has anything changed?
Injury
(2009) - et al.
Computed tomography whole body imaging in multi-trauma: 7 years experience
Clin Radiol
(2006) - et al.
30 years of polytrauma care: an analysis of the change in strategies and results of 4849 cases treated at a single institution
Injury
(2009) - et al.
Value of double reading of whole body CT in polytrauma patients
J Radiol
(2008) - et al.
Trainee reporting of computed tomography examinations: do they make mistakes and does it matter?
Clin Radiol
(2004) - et al.
Major trauma and cervical clearance radiation doses and cancer induction
Injury
(2008) - et al.
The benefit of multislice computed tomography in the emergency room management of polytraumatized patients
Eur J Trauma
(2005) - et al.
Missed injuries in trauma patients: a literature review
Patient Saf Surg
(2008) - et al.
Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation)
Eur Radiol
(2002)
Cited by (27)
Structured CT reports for patients with multiple trauma
2022, RadiologiaInterpretation of emergency CT scans in polytrauma: trauma surgeon vs radiologist
2020, African Journal of Emergency MedicineThe accuracy of interpretation of emergency abdominal CT in adult patients who present with non-traumatic abdominal pain: results of a UK national audit
2017, Clinical RadiologyCitation Excerpt :The selected audit standards are included in Table 1 (compliance with standards is also documented in this table). The standards were derived following careful evaluation of relevant, current published literature taking into account the differing clinical scenarios and definitions of discrepancy included in these publications.8–20 A comparison of the national audit findings against these standards were expressed as counts and percentages.
Comparison of clinically suspected injuries with injuries detected at whole-body CT in suspected multi-trauma victims
2015, Clinical RadiologyCitation Excerpt :Just under one-third of patients in the present study had normal CT examinations with no injuries to any of the body areas. Despite this being a significant proportion of all patients examined, the present findings are similar to those previously published in the literature.2,19,20 In the present study, 93% of patients had fewer body areas injured than clinically suspected.