Hoff William S, Sicoutris Corinna P, Lee Sun Y, Rotondo Michael F, Holstein James J, Gracias Vicente H, Pryor John P, Reilly Patrick M, Doroski Kenneth K, Schwab C William
Division of Traumatology and Surgical Critical Care, University of Pennsylvania Medical Center, Philadelphia, PA 18015, USA.
J Trauma. 2004 Feb;56(2):291-5. doi: 10.1097/01.TA.0000105924.37441.31.
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.
Over an 18-month period, 432 consecutive patients admitted to the trauma service at a Level II trauma center were studied prospectively. Radiographs obtained as part of the initial evaluation were initially interpreted by an attending trauma surgeon. All radiographs from the previous 24-hour admissions were reviewed by the trauma team with an attending radiologist at radiology rounds. New diagnoses (NDx) were defined as radiographic findings identified at radiology rounds that were not recorded by the trauma surgeon at the time of initial evaluation. The clinical significance of any NDx was described as follows: level 1, NDx resulted in significant morbidity/mortality; level 2, NDx resulted in alteration in care/no morbidity; level 3, NDx resulted in no alteration in care; level 4, NDx was an incidental finding by the radiologist; level 5, NDx by radiologist not definite.
Forty-seven NDx were identified in 42 patients (9.7%). Of the 47 NDx, 19 (40.4%) were level 3 and 28 (59.6%) were level 2. No level 1 NDx were identified. Forty-four changes in clinical management were documented in the level 2 group. Eight new consults were ordered in seven patients (16.7%): orthopedic surgery (n = 6), neurosurgery (n = 1), and physical therapy (n = 1). Seventeen additional diagnostic procedures were required in 16 patients (38.1%): plain radiographs (n = 11) and computed tomographic scans (n = 6). Nineteen therapeutic changes were required in 16 patients (38.1%): splint/immobilization device (n = 7), modified level of activity (n = 6), surgical procedures (n = 4), transfer (n = 1), and home equipment (n = 1).
A small number of radiographic findings are not detected by trauma surgeons during the initial evaluation. Although these findings are not of major clinical significance, the majority required some alteration in care plan. Formalized radiology rounds promotes clinical efficiency through early identification of these injuries, which facilitates any necessary alteration in the care plan.
有组织的创伤护理的一个重要目标是尽量减少延迟诊断和漏诊。创伤外科医生最初对X光片的不同解读是延迟诊断的一个独特来源。本研究的目的是评估作为三级检查一部分的正式放射科查房的效果。
在18个月的时间里，对一家二级创伤中心创伤科连续收治的432例患者进行了前瞻性研究。作为初始评估一部分获得的X光片最初由一位主治创伤外科医生解读。创伤团队在放射科查房时与一位主治放射科医生一起复查前24小时入院患者的所有X光片。新诊断（NDx）定义为在放射科查房时发现的X光片表现，而创伤外科医生在初始评估时未记录。任何NDx的临床意义描述如下：1级，NDx导致显著的发病率/死亡率；2级，NDx导致护理改变/无发病率；3级，NDx导致护理无改变；4级，NDx是放射科医生偶然发现的；5级，放射科医生的NDx不明确。
在42例患者中发现了47项NDx（9.7%）。在47项NDx中，19项（40.4%）为3级，28项（59.6%）为2级。未发现1级NDx。2级组记录了44项临床管理变化。7例患者（16.7%）被安排了8次新的会诊：骨科手术（n = 6）、神经外科（n = 1）和物理治疗（n = 1）。16例患者（38.1%）需要进行17项额外的诊断程序：X光平片（n = 11）和计算机断层扫描（n = 6）。16例患者（38.1%）需要进行19项治疗改变：夹板/固定装置（n = 7）、活动水平调整（n = 6）、手术程序（n = 4）、转院（n = 1）和家庭设备（n = 1）。
创伤外科医生在初始评估期间未检测到少数X光片表现。虽然这些表现不具有重大临床意义，但大多数需要对护理计划进行一些调整。正式的放射科查房通过早期识别这些损伤提高了临床效率，这有助于对护理计划进行任何必要的调整。
