Type:
Educational Exhibit
Keywords:
Emergency Imaging, Emergency, CT, Audit and standards, Structured reporting, Technical aspects, Acute, Quality assurance, Trauma, Not applicable
Authors:
J. Weaver1, W. P. Topping1, J. Chui2, J. Su2; 1Stevenage/UK, 2London/UK
DOI:
10.26044/ecr2020/C-13680
Findings and procedure details
Method
- Retrospective audit
- Single centre
- All whole body MDCT performed during the period 19/07/2019 - 18/09/2019 - two months
- Hospital central radiology information system (CRIS) searched by three auditors
- N = 73
- Five audit standards
Fig. 4: Audit standards
References: © Radiology, East and North Herfordshire NHS Trust, Lister Hospital - Stevenage/UK
- "Significant injuries" were identified within the written reports according to the injury severity criteria from the hospital trauma radiology guidelines:
- Intracranial haemorrhage
- Fracture of the pelvis (not a fracture of the neck of the femur)
- Multiple injuries, especially where the risk of haemodynamic instability is a consideration
Results
The results are tabulated.
Fig. 6: Audit results graph
Discussion
- There is no dedicated polytrauma request form in use at our centre
- Significant injuries were identified in just over a quarter (20/73, 27%)
Fig. 8: Fractures. (A) Femoral shaft fracture in a patient following a fall down the stairs. (B) Superior pubic ramus fracture in a patient following a pedestrian vs car road traffic accident. (C) Flail chest following trampling.
Fig. 9: Spinal cord injury. (A) Sagittal CT cervical spine in a patient following a fall. (B) Sagittal T2 weighted MRI in the same patient demonstrating central cord signal change.
Fig. 10: Intracranial injuries. (A) Axial CT skull demonstrating a right orbital fracture with orbital emphysema in a patient following a fall. (B) Coronal CT brain demonstrating acute subdural haematoma in a paedestrian struck by a vehicle. (C&D) Axial CT brain and 3D reformat showing an acute occipital bone fracture with acute subdural haematoma in a patient following a fall from stairs.
Fig. 11: Axial CT thorax in a motorcyclist following a road traffic collision. There are bilateral pneumothoraces with pneumopericardium and tamponade.
- 18 studies were performed without fulfiling the request criteria
- The majority of reports do not follow the ATLS system and issue a full report
- Two cases did not meet the request criteria but had significant injuries identified - these could have been identified on a more limited study
- A quarter of studies are not reported within the time frame of 60 minutes
- Half of those not reported in the time frame were reported provisionally by a registrar, pending consultant approval. The other half were reported by the out-of-hours teleradiology consultant service.
Limitations
- The primary survey may have been verbally communicated to the trauma team leader but not recorded within the departmental RIS
- Reporting within the time-frame may have been limited by Picture archiving and communication system (PACS) downtime, either expected or unexpected.
Recommendations for Quality Improvement
- Electronic requesting software (ICE) to contain dedicated trauma series
- Roll out dedicated polytrauma request form
- Create shortcodes for reporting primary and secondary surveys