Robinson Jeffrey D, Linnau Ken F, Hippe Daniel S, Sheehan Kellie L, Gross Joel A
Department of Radiology, University of Washington, 325 9th Avenue, Box 359728, Seattle, WA, 98104, USA.
Emerg Radiol. 2018 Apr;25(2):169-173. doi: 10.1007/s10140-017-1573-8. Epub 2017 Dec 27.
Growing numbers of patient with advanced imaging being transferred to trauma centers has resulted in increased numbers of outside CT scans received at trauma centers. This study examines the degree of agreement between community radiologists' interpretations of the CT scans of transferred patients and trauma center radiologists' reinterpretation.
All CT scans of emergency transfer patients received over a 1 month period were reviewed by an emergency radiologist. Patients were classified as trauma or non-trauma and exams as neuro or non-neuro. Interpretive discrepancies between the emergency radiologist and community radiologist were classified as minor, moderate, or major. Major discrepancies were confirmed by review of a second emergency radiologist. Discrepancy rates were calculated on a per-patient and per exam basis.
Six hundred twenty-seven CT scans of 326 patients were reviewed. Major discrepancies were encountered in 52 (16.0%, 95% CI 12.2-20.5) patients and 53 exams (8.5%, 95% CI 6.5-10.5). These were discovered in 46 trauma patients (21.6%, 95% CI 16.4-27.9) compared to six non-trauma patients (5.3%, 95% CI 2.2-11.7) (P < 0.001). A significant difference in the major discrepancy rate was also found between non-neuro and neuro exams (12.4 vs 3.3%, respectively, P < 0.001), primarily due to discrepancies in trauma patients, rather than non-trauma patients.
Potentially management-changing interpretive changes affected 16% of transferred patients and 8.5% of CT exams over a 1 month period. Trauma center reinterpretations of community hospital CT scans of transferred patients provide valuable additional information to the clinical services caring for critically ill patients.
越来越多有高级影像检查结果的患者被转送至创伤中心，导致创伤中心接收的外院CT扫描数量增加。本研究旨在探讨社区放射科医生对转院患者CT扫描的解读与创伤中心放射科医生重新解读之间的一致程度。
一名急诊放射科医生对在1个月期间接收的所有急诊转院患者的CT扫描进行了回顾。将患者分为创伤性或非创伤性，检查分为神经科或非神经科。急诊放射科医生与社区放射科医生之间的解读差异分为轻微、中度或重度。重度差异由另一名急诊放射科医生复查确认。按每位患者和每次检查计算差异率。
对326例患者的627次CT扫描进行了回顾。在52例（16.0%，95%置信区间12.2 - 20.5）患者和53次检查（8.5%，95%置信区间6.5 - 10.5）中发现了重度差异。与6例非创伤性患者（5.3%，95%置信区间2.2 - 11.7）相比，在46例创伤性患者（21.6%，95%置信区间16.4 - 27.9）中发现了这些差异（P < 0.001）。在非神经科和神经科检查之间也发现了重度差异率的显著差异（分别为12.4%和3.3%，P < 0.001），主要是由于创伤性患者而非非创伤性患者存在差异。
在1个月期间，可能改变治疗方案的解读变化影响了16%的转院患者和8.5%的CT检查。创伤中心对转院患者社区医院CT扫描的重新解读为照料重症患者的临床服务提供了有价值的额外信息。
