放射科在儿科骨科门诊进行二次阅片是否有价值？

Natarajan Vivek, Bosch Patrick, Dede Ozgur, Deeney Vincent, Mendelson Stephen, Ward Timothy, Brooks Maria, Kenkre Tanya, Roach James

*Children's Hospital of Pittsburgh †University of Pittsburgh School of Public Health, Pittsburgh, PA.

J Pediatr Orthop. 2017 Jun;37(4):e292-e295. doi: 10.1097/BPO.0000000000000917.

BACKGROUND

The Joint Commission on Accreditation of Healthcare Organizations specifically mandates the dual interpretation of musculoskeletal radiographs by a radiologist in addition to the orthopaedist in all hospital-based orthopaedic clinics. Previous studies have questioned the utility of this practice. The purpose of this study was to further investigate the clinical significance of having the radiologist provide a second interpretation in a hospital-based pediatric orthopaedic clinic.

METHODS

A retrospective review was performed of all patients who had plain radiographs obtained in the pediatric orthopaedic clinic at an academic children's hospital over a 4-month period. For each radiographic series, the orthopaedist's note and the radiology interpretation were reviewed and a determination was made of whether the radiology read provided new clinically useful information and/or a new diagnosis, whether it recommended further imaging, or if it missed a diagnosis that was reflected in the orthopaedist's note. The hospital charges associated with the radiology read for each study were also quantified.

RESULTS

The charts of 1570 consecutive clinic patients who were seen in the pediatric orthopaedic clinic from January to April, 2012 were reviewed. There were 2509 radiographic studies performed, of which 2264 had both a documented orthopaedist's note and radiologist's read. The radiologist's interpretation added new, clinically important information in 1.0% (23/2264) of these studies. In 1.7% (38/2264) of the studies, it was determined that the radiologist missed the diagnosis or clinically important information that could affect treatment. The total amount of the professional fees charged for the radiologists' interpretations was $87,362. On average, the hospital charges for each occurrence in which the radiologist's read provided an additional diagnosis or clinically important information beyond the orthopaedist's note were $3798.

CONCLUSIONS

The results of this study suggest that eliminating the requirement to have the radiologist interpret radiographs in the pediatric orthopaedic clinic would have few clinical consequences.

LEVEL OF EVIDENCE

Level III-This is a diagnostic retrospective cohort study.

背景

医疗机构评审联合委员会特别规定，在所有医院的骨科诊所中，除骨科医生外，放射科医生还应对肌肉骨骼X光片进行双重解读。以往的研究对这种做法的实用性提出了质疑。本研究的目的是进一步调查在医院的儿科骨科诊所中，由放射科医生进行二次解读的临床意义。

方法

对一家学术儿童医院儿科骨科诊所在4个月内进行普通X光检查的所有患者进行回顾性研究。对于每个X光检查系列，审查骨科医生的记录和放射科解读，并确定放射科的解读是否提供了新的临床有用信息和/或新诊断，是否建议进一步成像，或者是否遗漏了骨科医生记录中反映的诊断。还对每项研究的放射科解读相关的医院费用进行了量化。

结果

回顾了2012年1月至4月在儿科骨科诊所就诊的1570例连续门诊患者的病历。共进行了2509次X光检查，其中2264次既有骨科医生的记录又有放射科医生的解读。放射科医生的解读在1.0%（23/2264）的这些研究中增加了新的、临床重要信息。在1.7%（38/2264）的研究中，确定放射科医生遗漏了可能影响治疗的诊断或临床重要信息。放射科医生解读的专业费用总额为87362美元。平均而言，放射科解读在骨科医生记录之外提供额外诊断或临床重要信息的每次事件的医院费用为3798美元。