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Impact on patient care of discordance in radiology readings between external overnight radiology services and staff radiology readings at a level 1 trauma center

Published on Mar 1, 2013in American Journal of Surgery2.20
· DOI :10.1016/j.amjsurg.2012.10.017
Tutu Cheng1
Estimated H-index: 1
(Conemaugh Health System),
Russell Dumire4
Estimated H-index: 4
(Conemaugh Health System)
+ 1 AuthorsJames S. Gregory2
Estimated H-index: 2
(Conemaugh Health System)
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Abstract
Abstract Background Overnight radiology services (ORSs) provide computed tomography (CT) scan readings that are automatically reviewed by staff radiologists (SRs) and the trauma service. Discordant readings and their clinical significance were investigated. Methods ORS-read CT scans over 3 years were reviewed. A discordant reading was clinically significant if it resulted in a substantive change in patient care. All clinically significant findings were reviewed by a blinded radiologist. Results Five hundred thirty-four CT scans were identified: 191 (35.8%) head, 187 (35%) cervical, 66 (12.4%) chest, and 90 (16.9%) abdomen/pelvis scans. One hundred twenty-three scans (23%) were abnormal with a DR of 16%: 5 head, 2 cervical, 7 chest, and 6 abdomen/pelvis scans. Seven (6%) scans had clinically significant findings missed: 3 head and 4 abdomen/pelvis scans. ORSs missed 7, and SRs missed 3 clinically significant findings. A blinded radiologist confirmed the clinically significant findings. Conclusions The discordant rate of readings for abnormal CT scans was 16% with 37% considered to be clinically significant. ORSs missed 100%, and 29% of the clinically significant findings were identified after SR/trauma service rounds. SR/trauma service review of ORS readings is supported.
  • References (9)
  • Citations (5)
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References9
Newest
Published on Feb 1, 2012in Acta Radiologica1.59
Owen D Terreblanche1
Estimated H-index: 1
(University of the Witwatersrand),
Savvas Andronikou21
Estimated H-index: 21
(University of the Witwatersrand)
+ 2 AuthorsPieter E Boshoff1
Estimated H-index: 1
(University of the Witwatersrand)
BackgroundThere is a heavy reliance on registrars for after-hours CT reporting with a resultant unavoidable error rate.PurposeTo determine the after-hours CT reporting error rate by radiology registrars and influencing factors on this error rate.Material and MethodsA 2-month prospective study was undertaken at two tertiary, level 1 trauma centers in Johannesburg, South Africa. Provisional CT reports issued by the registrar on call were reviewed by a qualified radiologist the following morning an...
Published on Jun 1, 2011in Journal of The American College of Radiology3.79
Julie A. Ruma4
Estimated H-index: 4
(UM: University of Michigan),
Katherine A. Klein14
Estimated H-index: 14
(UM: University of Michigan)
+ 4 AuthorsJames D. Myles15
Estimated H-index: 15
(UM: University of Michigan)
Purpose The aim of this study was to identify the rate of discrepancies between radiology residents and faculty radiologists at an academic hospital and to determine the distribution across subspecialties and modalities, specifically CT, MR, and ultrasound. Methods Consecutive CT, MR, and ultrasound preliminary interpretations rendered by on-call second-year through fourth-year radiology residents for 9 months on emergency department patients, inpatients, and urgent outpatients formed the study ...
Published on Sep 1, 2008in Academic Radiology2.27
Victoria F. Cooper1
Estimated H-index: 1
(NU: Northwestern University),
Lori Ann Goodhartz4
Estimated H-index: 4
(NU: Northwestern University)
+ 1 AuthorsRobert K. Ryu45
Estimated H-index: 45
(NU: Northwestern University)
Rationale and Objectives To determine the incidence of radiology resident preliminary interpretation errors for plain film, body computed tomography, and neuroradiology (neuro)computed tomographic examinations read on call. Materials and Methods We retrospectively reviewed the data in a prospectively acquired resident quality assurance (QA) database dating between January 2000 and March 2007. The database comprises all imaging studies initially interpreted by an on-call resident and later review...
Published on Oct 1, 2007in American Journal of Neuroradiology3.26
William M. Strub9
Estimated H-index: 9
,
James L. Leach21
Estimated H-index: 21
+ 1 AuthorsAchala Vagal15
Estimated H-index: 15
BACKGROUND AND PURPOSE: Our aim was to determine the patterns of error of radiology residents in the detection of intracranial hemorrhage on head CT examinations while on call. Follow-up studies were reviewed to determine if there was any adverse effect on patient outcome as a result of these preliminary interpretations. MATERIALS AND METHODS: Radiology residents prospectively interpreted 22,590 head CT examinations while on call from January 1, 2002, to July 31, 2006. The following morning, the...
William S. Hoff20
Estimated H-index: 20
,
Corinna Sicoutris9
Estimated H-index: 9
+ 7 AuthorsC. William Schwab46
Estimated H-index: 46
Background: An important objective of organized trauma care is to minimize delayed diagnoses and missed injuries. Discrepant interpretations of radiographs initially read by trauma surgeons represent a unique source of delayed diagnoses. The purpose of this study was to evaluate the efficacy of formalized radiology rounds as a component of the tertiary survey. Methods: Over an 18-month period, 432 consecutive patients admitted to the trauma service at a Level II trauma center were studied prospe...
Published on Aug 1, 2003in American Journal of Roentgenology3.16
Erin Carney1
Estimated H-index: 1
,
Jeffrey S. Kempf8
Estimated H-index: 8
+ 2 AuthorsJohn L. Nosher22
Estimated H-index: 22
OBJECTIVE. At many academic institutions, preliminary interpretations of CT scans and sonograms obtained after regular hours of operation are performed by radiology residents, with attending radiologists reviewing the interpretations the next morning. We sought to determine the rate of discrepancy between residents' interpretations of imaging studies and the final interpretations performed by an attending body imaging radiologist as well as any resulting clinical consequences stemming from the d...
Published on Dec 1, 2001in Clinical Radiology2.08
R. Fitzgerald2
Estimated H-index: 2
(New Cross Hospital)
Abstract Literature review indicates high levels of error within radiology. The aetiology of radiological error is multi-factorial. While individuals have a duty to progressively improve their performance, the experience of safety cultures in other high-risk human activities has shown that a system approach of root cause analysis is the method required to reduce error significantly. FitzGerald, R. (2001). Clinical Radiology 56 , 938–946.
Published on Dec 1, 2001in American Surgeon0.61
George V Velmanos75
Estimated H-index: 75
,
C Fili2
Estimated H-index: 2
+ 3 AuthorsAlison Wilcox8
Estimated H-index: 8
Financial constraints due to increasing operating cost and decreased reimbursement do not allow many hospitals to maintain coverage by attending radiologists around the clock (CARAC). Preliminary film readings by radiology trainees may be inaccurate. In trauma, decisions are made fast and are often based on these preliminary readings. To examine whether there are significant discrepancies between preliminary readings (PRs) and final readings (FRs) of CT scans of trauma patients we prospectively ...
Published on Nov 1, 1995in American Journal of Roentgenology3.16
Douglas R. DeCorato1
Estimated H-index: 1
,
Nolan J. Kagetsu3
Estimated H-index: 3
,
Ronald C. Ablow16
Estimated H-index: 16
The purpose of our study was to assess the efficacy of a commercially available digital teleradiology system in the off-site interpretation of radiologic studies performed in the emergency department.Over a 6-month period, all radiologic studies performed at Roosevelt Hospital between the hours of midnight and 8 A.M. were digitized and then transmitted over a T1 fiberoptic link to the radiology department of St. Luke's Hospital, 4.8 km away. A total of 829 radiologic examinations were performed,...
Cited By5
Newest
Published on Nov 14, 2018in Hernia2.29
Deepa V. Cherla3
Estimated H-index: 3
(University of Texas Health Science Center at Houston),
Karla Bernardi1
Estimated H-index: 1
(University of Texas Health Science Center at Houston)
+ 11 AuthorsKaustubh G. Shiralkar (University of Texas Health Science Center at Houston)
Purpose Increasingly, radiologic imaging is obtained as part of the pathway in diagnosing ventral hernias. Often, radiologists receive incomplete or incorrect clinical information from clinicians. Objective: The aim of the study is to determine if clinical exam findings alter radiological interpretation of ventral hernias on CT.
Published on Feb 1, 2018in Journal of Digital Imaging2.57
Hailey H Choi1
Estimated H-index: 1
(MedStar Georgetown University Hospital),
Jennifer Clark1
Estimated H-index: 1
(Georgetown University)
+ 1 AuthorsRoss W. Filice3
Estimated H-index: 3
(MedStar Georgetown University Hospital)
Feedback is an essential part of medical training, where trainees are provided with information regarding their performance and further directions for improvement. In diagnostic radiology, feedback entails a detailed review of the differences between the residents’ preliminary interpretation and the attendings’ final interpretation of imaging studies. While the on-call experience of independently interpreting complex cases is important to resident education, the more traditional synchronous “rea...
Published on Jun 1, 2017in European Radiology3.96
K. Treskes3
Estimated H-index: 3
(AMC: Academic Medical Center),
S. A. Bos1
Estimated H-index: 1
(AMC: Academic Medical Center)
+ 9 AuthorsM. W. Hollmann1
Estimated H-index: 1
(AMC: Academic Medical Center)
Objectives To determine whether there is a difference in frequency and clinical relevance of incidental findings detected by total-body computed tomography scanning (TBCT) compared to those by the standard work-up (STWU) with selective computed tomography (CT) scanning.
Published on Jan 1, 2015in Journal of The American College of Radiology3.79
Brent D. Weinberg16
Estimated H-index: 16
(UTSW: University of Texas Southwestern Medical Center),
Michael Richter4
Estimated H-index: 4
(UTSW: University of Texas Southwestern Medical Center)
+ 2 AuthorsTravis Browning5
Estimated H-index: 5
(UTSW: University of Texas Southwestern Medical Center)
Abstract Purpose The objective of this paper is to assess the volume, accuracy, and timeliness of radiology resident preliminary reports as part of an independent call system. This study seeks to understand the relationship between resident year in training, study modality, and discrepancy rate. Methods Resident preliminary interpretations on radiographs, ultrasound, CT, and MRI from October 2009 through December 2013 were prospectively scored by faculty on a modified RADPEER scoring system. Dis...
Joanne C. Sierink9
Estimated H-index: 9
,
Teun Peter Saltzherr13
Estimated H-index: 13
+ 4 AuthorsJ. C. Goslings16
Estimated H-index: 16
Abstract Introduction Total-body Computed Tomography (CT) scans are increasingly used in trauma care. Herewith the observation of incidental findings, trauma unrelated findings, is also increased. The aim of this study was to evaluate the number of incidental findings in adult trauma patients. Patients and methods All consecutive trauma patients that underwent total-body CT scanning between January 2009 and December 2011 were analysed. Incidental findings were divided in three categories: catego...
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