Department of Internal Medicine, Gunderson Lutheran Medical Center, La Crosse, WI, USA.
AJR Am J Roentgenol. 2012 Oct;199(4):916-20. doi: 10.2214/AJR.11.7662.
The objective of our study was to identify whether a substantive difference exists between the imaging interpretations of radiologists at outside referring institutions and those of radiologists at a tertiary care children's hospital and whether such reinterpretation affects the clinical management of pediatric patients.
This retrospective chart review examined the diagnostic imaging reports of all pediatric patients referred to a tertiary care freestanding children's hospital over a 17-month period (January 1, 2009-May 31, 2010); 773 examinations met the inclusion criteria. The original and second interpretations were compared. A fellowship-trained pediatric radiologist and neuroradiologist categorized each case using the content of the two radiology reports as agreement versus minor or major disagreement, and the results were analyzed for statistical significance. A cohort of cases in which a final diagnosis could be confirmed was also analyzed to evaluate the accuracy of both interpretations.
Disagreements were found in 323 of 773 reports (41.8%): 168 (21.7%) were major and 155 (20.0%), minor. Neurologic studies were most frequently requested for reinterpretation, 427 (55.2%), most commonly in the setting of trauma, 286 (67.0%). Among the 427 neuroimaging studies, major and minor disagreements occurred in 54 (12.6%) and 91 (21.3%) cases, respectively. Major disagreements most frequently observed were about the presence of fracture and hemorrhage. Among 305 body imaging cases, major and minor disagreements occurred in 99 (32.6%) and 57 (18.7%) cases, respectively. The most common setting for nontraumatic body imaging was concern for appendicitis (168/305 [55.1%]); this indication for imaging was responsible for 40.3% of major disagreements in nontraumatic abdominal imaging. Reinterpretation was rarely requested for radiographic studies (41/773 [5.3%]), which had major and minor disagreement rates of 36.6% and 17.1%, respectively. In the cohort of cases analyzed for final diagnosis, the second interpretation was more accurate than the original in 90.2% of cases with a p value of less than 0.0001.
Our findings suggest that discrepancy rates for second interpretations in studies of pediatric patients transferred to tertiary care pediatric institutions are substantial. Although the original and second interpretations in the majority of cases were in agreement, major discrepancies were prevalent--12.6% and 32.6% of neuroimaging and body studies, respectively--and the second interpretations were significantly correlated with the final diagnosis. These results indicate that interpretations by subspecialty radiologists at a point-of-care facility provide important clinical information about the pediatric patient and should be recognized by payers as integral to optimal care.
我们的研究目的是确定外部转诊机构的放射科医生与三级儿童保健医院的放射科医生的影像学解读之间是否存在实质性差异，以及这种重新解读是否会影响儿科患者的临床管理。
本回顾性图表研究检查了在 17 个月期间（2009 年 1 月 1 日至 2010 年 5 月 31 日）转诊至三级独立儿童医院的所有儿科患者的诊断影像学报告；符合纳入标准的有 773 项检查。比较了原始和第二次解读。一名接受过儿科放射学专业培训的放射科医生和神经放射科医生使用两份放射学报告的内容对每个病例进行分类，结果为一致或轻微或重大分歧，并对结果进行了统计学分析。还分析了一组可以确认最终诊断的病例，以评估两种解释的准确性。
在 773 份报告中有 323 份（41.8%）存在分歧：168 份（21.7%）为重大分歧，155 份（20.0%）为轻微分歧。神经影像学研究是最常要求重新解读的，有 427 项（55.2%），最常见的情况是创伤，286 项（67.0%）。在 427 项神经影像学研究中，重大和轻微分歧分别发生在 54 项（12.6%）和 91 项（21.3%）病例中。最常见的重大分歧是骨折和出血的存在。在 305 项身体成像病例中，重大和轻微分歧分别发生在 99 项（32.6%）和 57 项（18.7%）病例中。非创伤性身体成像最常见的适应证是阑尾炎（168/305 [55.1%]）；这一成像指征导致非创伤性腹部成像的重大分歧率为 40.3%。放射学研究很少要求重新解读（41/773 [5.3%]），其重大和轻微分歧率分别为 36.6%和 17.1%。在分析最终诊断的病例队列中，第二次解读的准确性在 90.2%的病例中高于第一次，p 值小于 0.0001。
我们的研究结果表明，转至三级儿童保健机构的儿科患者的研究中，第二次解读的差异率很大。尽管大多数情况下原始和第二次解读是一致的，但重大分歧很常见——神经影像学和身体影像学研究分别为 12.6%和 32.6%——第二次解读与最终诊断显著相关。这些结果表明，在护理点医疗机构工作的放射科专家的解读为儿科患者提供了重要的临床信息，应被付款人视为最佳护理的重要组成部分。
