SEATTLE - Trauma patients might escape further trauma if radiologists are calling the shots. That's the hesitant but apparent conclusion of a study conducted at Baystate Medical Center in Springfield, MA.
The retrospective study, presented Monday at the American Roentgen Ray Society meeting, went beyond the well-trodden ground of how radiologists and nonradiologists interpret radiologic studies differently. It looked at how those discrepancies would have affected patient management in admission triage decisions.
The study reviewed abdomino-pelvic CT scans that had been acquired in 100 patients -- 70 males and 30 females ages 18-95 -- who presented to the level-one trauma center between December 1999 and June 2000. The scans were examined by a single trauma surgeon who was not involved in the patients' initial care.
To render his interpretations, the trauma surgeon was given the same information the radiologists had when the initial triage decisions were made, including the initial patient survey and postraumatic CT scan. Based on this data, the trauma surgeon made his own triage decision for each patient.
"We then compared the retrospective CT scan interpretation and his triage decision to the actual radiologist's report and the actual triage decision," said Dr. Mazen Ghani, a radiologist from the trauma center who led the study. "The total number of discrepancies between the radiologist's decision and the radiology report were then identified, and of these the potentially significant discrepancies were divided into false-negative and false-positive, and further characterized as major and minor."
Major discrepancies were defined as those that required immediate intervention, while minor discrepancies required either no intervention, close follow-up or minor therapy, Ghani said.
Forty-five of the 100 scans showed abnormalities, and several contained more than one. The radiologist-identified pathologies included 15 solid organ injuries, 12 cases of hemoperitoneum or retroperitoneal bleeding, and 3 hollow viscus injuries. There was agreement between the findings of the trauma surgeon and the radiologist in 62 patients, while 38 scans contained discrepancies, 36 of which were potentially significant, Ghani said.
There were 26 major false-negative discrepancies in 19 patients, 4 minor false-negative discrepancies in 4 patients, 31 major false-positive discrepancies in 21 patients, and 1 minor false-positive discrepancy. Several scans had more than one discrepancy.
Of 26 major false-negative discrepancies noted in 19 patients, the most common categories were bone and pelvis injuries, in 14 and 3 patients respectively. The most common false-negative reading involved abdominal wall hematoma. The most common false-positive readings involved interpreted solid organ and bone injuries in 15 and 5 patients prospectively, he said.
Patient management
A triage decision (admit to floor, ICU, OR, or discharge) was made for each patient who presented to the center. While all 100 patients were actually admitted, at least for observation, the trauma surgeon would have discharged five. Thirty-five of 36 cases with major discrepancies would have been managed appropriately, while one would have been inappropriately managed, Ghani said.
"This patient was actually taken to the operating room because of the suggestion of bowel injury on the CT scan. This patient would have been discharged by the trauma surgeon," said Ghani. Subsequent laparatomy revealed an appendiceal abscess.
Ghani noted three study limitations, including a relatively small sample group, the retrospective nature of the study, and its reliance on a single trauma surgeon.
Session moderator Dr. Robert Novelline from Massachusetts General Hospital in Boston asked Ghani what the study implied. Should radiologists be available 24 hours a day at every trauma center?
"No," Ghani said. "The bottom line is that radiologists should be involved in the interpretation of CT scans." It's also fair to conclude that trauma surgeons shouldn't make patient-management decisions based on their own interpretation of CT scans of the bowel, he said.
By Eric Barnes
AuntMinnie.com staff writer
May 1, 2001
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