Karmazyn Boaz, Wanner Matthew R, Marine Megan B, Tilmans Luke, Jennings S Gregory, Hibbard Roberta A
Department of Radiology and Imaging Sciences, Riley Hospital for Children, 705 Riley Hospital Drive, Rm. 1053, Indianapolis, IN, 46202, USA.
Indiana University School of Medicine, 340 W 10th St, Indianapolis, IN, 46202, USA.
Pediatr Radiol. 2019 Feb;49(2):203-209. doi: 10.1007/s00247-018-4276-8. Epub 2018 Oct 26.
Fractures are the second most common finding in non-accidental trauma after cutaneous signs. Interpreting skeletal surveys could be challenging as some fractures are subtle and due to anatomical variations that can mimic injuries.
To determine the effect of a second read by a pediatric radiologist of skeletal surveys for suspected non-accidental trauma initially read at referring hospitals by general radiologists.
In 2016 and 2017, we identified all patients referred to our children's hospital with previous surveys performed and read at a community hospital by an outside radiologist. We excluded patients older than 3 years and studies performed at a children's hospital. The surveys were reviewed by a pediatric radiologist with the printed outside report available. Surveys with disagreement between outside read and pediatric radiologist read were reviewed by a second pediatric radiologist. A disagreement in the second read included only definite discrepant findings agreed upon by both pediatric radiologists. The Fisher exact test was performed to compare the ratio of discrepancies between readers in normal and abnormal surveys.
Two hundred twenty-five surveys were performed (120 male) at 62 referring hospitals, with a mean patient age of 10.5 months (range: 5 days-3 years). The outside read identified fractures in 104/225 (46.2%) surveys. Thirty-seven of the 225 (16.4%) contained discrepancies in interpretation (n=111). Most of these disagreements (29/37, 78.4%) resulted in a significant change in the report. There was a significant (P<0.0001) difference between disagreement rate in outside read negative (4/111, 3.2%) and positive surveys (34/104, 31.7%). The second read identified additional fractures in 22/225 (9.8%) of the surveys and disagreed with first-read fractures in 17/256 (7.6%). Four of 19 (21.1%) classic metaphyseal lesions diagnosed by the outside read were normal variants; 18 classic metaphyseal lesions were missed by the outside read.
This study supports second reads by pediatric radiologists of skeletal surveys for non-accidental trauma.
骨折是继皮肤体征之后非意外创伤中第二常见的表现。解读骨骼检查可能具有挑战性，因为一些骨折很细微，且由于解剖变异可能会与损伤相似。
确定儿科放射科医生对疑似非意外创伤的骨骼检查进行二次阅片的效果，这些检查最初由综合医院的放射科医生在转诊医院进行阅片。
在2016年和2017年，我们确定了所有转诊至我院儿童医院的患者，他们之前在社区医院由外部放射科医生进行了检查并阅片。我们排除了3岁以上的患者以及在儿童医院进行的检查。儿科放射科医生在有外部打印报告的情况下对这些检查进行了复查。外部阅片与儿科放射科医生阅片存在分歧的检查由另一位儿科放射科医生进行复查。二次阅片中的分歧仅包括两位儿科放射科医生都认可的明确不同的发现。采用Fisher精确检验来比较正常和异常检查中阅片者之间的差异比例。
在62家转诊医院进行了225次检查（120例男性），患者平均年龄为10.5个月（范围：5天至3岁）。外部阅片在104/225（46.2%）的检查中发现了骨折。225次检查中有37次（16.4%）在解读上存在差异（n = 111）。这些分歧中的大多数（29/37，78.4%）导致报告有重大变化。外部阅片阴性（4/111，3.2%）和阳性检查（34/104，31.7%）的分歧率之间存在显著差异（P < 0.0001）。二次阅片在22/225（9.8%）的检查中发现了额外的骨折，并且在17/256（7.6%）的检查中与首次阅片发现的骨折存在分歧。外部阅片诊断的19例（21.1%）经典干骺端病变中有4例为正常变异；外部阅片漏诊了18例经典干骺端病变。
本研究支持儿科放射科医生对疑似非意外创伤的骨骼检查进行二次阅片。
