Purpose
Initial evaluation of trauma patients involves identifying clinically important cervical spine injury (CSI) which if undiagnosed and untreated can lead to serious consequences such as quadriplegia and death. This often necessitates cervical imaging with cervical spine CT (CCT). Like many teaching hospitals in Australia, after-hours CT reporting at our institution is undertaken by the on-call radiology registrar. Many hospital protocols recommend patients to remain in spinal precautions until the report is finalised by a consultant, although there are very few studies to support this practice....
Methods and materials
The interim registrar reports for all CCTs performed after-hours over a 12-month period were retrospectively reviewed. The final consultant report was used as the gold standard to establish accuracy of the registrar report. The primary outcome was discrepancy between the provisional and final reports. Any discrepancy was classified as either an ‘overcall’ or ‘miss’. Discrepancies were graded by the RADPEER scoring system.
Results
A total of 1084 after-hours CCT studies were reviewed. The cohort comprised 1062 patients, with 615 males (56.7%) and 469 females (43.3%). The mean and median ages were 54.7 and 55.0 years respectively (range 16 -100 years). The number of cases positive for injury was 37 (3.4%). The total number of discrepancies was 14 (discrepancy rate 1.3%), including 4 overcalls (0.3%) and 10 misses (0.9%). The discrepancy rates for junior and senior registrars were 1.7% and 0.7%, respectively. Only 5 misses (0.5%) were considered clinically...
Conclusion
Registrars reporting after-hours CCT have low rates of discrepancy with very few clinically significant misses. However, the reduced registrar sensitivity for detection of cervical injury highlights the ongoing importance of consultant review in the process of cervical spine clearance pathways.
References
Ruchman RB, Jaeger J, Wiggins EF III, Seinfeld S, Thakral V, Bolla S, et al. Preliminary Radiology Resident Interpretations Versus Final Attending Radiologist Interpretations and the Impact on Patient Care in a Community Hospital. Am J Neuroradiol 2007; 189(3): 523-526. doi: 10.2214/AJR.07.2307
Van A, Asadi H, Robertson P. Accuracy of Preliminary Registrar CTPA Reports: An Audit of the Differences between Preliminary Registrar and Finalised Consultant Reports. J Med Imaging Radiat Oncol 2015; 59 (Suppl. S1): 158. doi: 10.1594/ranzcr2015/R-0113
Miyakoshi A, Nguyen QT, Cohen WA, Talnar...