From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias).
Department of Surgery, University of Southern California (USC), Los Angeles, CA (Grigorian).
J Am Coll Surg. 2022 Sep 1;235(3):500-509. doi: 10.1097/XCS.0000000000000280. Epub 2022 Aug 10.
Overnight radiology coverage for trauma patients is often addressed with a combination of on-call radiology residents (RR) and a teleradiology service; however, the accuracy of these 2 readers has not been studied for trauma. We aimed to compare the accuracy of RR versus teleradiologist interpretations of CT scans for trauma patients.
A retrospective analysis (March 2019 through May 2020) of trauma patients presenting to a single American College of Surgeons Level I trauma center was performed. Patients whose CT scans were performed between 10 pm to 8 am were included, because their scans were interpreted by both a RR and teleradiologist. Interpretations were compared with the final attending faculty radiologist's interpretation and graded for accuracy based on the RADPEER scoring system. Discrepancies were characterized as traumatic injury or incidental findings and missed findings or overcalls. Turnaround time was also compared.
A total of 1,053 patients and 8,226 interpretations were included. Compared with teleradiologists, RR had a lower discrepancy (7.7% vs 9.0%, p = 0.026) and major discrepancy rate (3.8% vs 5.2%, p = 0.003). Among major discrepancies, RR had a lower rate of traumatic injury discrepancies (3.2% vs 4.4%, p = 0.004) and missed findings (3.4% vs 5.1%, p < 0.001), but a higher rate of overcalls (0.5% vs 0.1%, p < 0.001) compared with teleradiologists. The mean turnaround time was shorter for RR (51.3 vs 78.8 minutes, p < 0.001). The combination of both RR and teleradiologist interpretations had a lower overall discrepancy rate than RR (5.0% vs 7.7%, p < 0.001).
This study identified lower discrepancy rates and a faster turnaround time by RR compared with teleradiologists for trauma CT studies. The combination of both interpreters had an even lower discrepancy rate, suggesting this combination is optimal when an in-house attending radiologist is not available.
创伤患者的夜间放射学检查通常由放射科住院医师（RR）和远程放射学服务共同负责；然而，尚未对这两种阅片者在创伤方面的准确性进行研究。我们旨在比较 RR 和远程放射科医生对创伤患者 CT 扫描的解读准确性。
对一家美国外科医师学会一级创伤中心的创伤患者进行了回顾性分析（2019 年 3 月至 2020 年 5 月）。将在晚上 10 点至早上 8 点之间进行 CT 扫描的患者纳入研究，因为他们的扫描由 RR 和远程放射科医生共同解读。将这些解读与最终主治放射科医生的解读进行比较，并根据 RADPEER 评分系统对准确性进行分级。对差异进行分类，分为创伤性损伤或偶发发现、漏诊或过度诊断。同时还比较了周转时间。
共纳入 1053 例患者和 8226 次解读。与远程放射科医生相比，RR 的差异率（7.7%比 9.0%，p = 0.026）和主要差异率（3.8%比 5.2%，p = 0.003）较低。在主要差异中，RR 的创伤性损伤差异率（3.2%比 4.4%，p = 0.004）和漏诊率（3.4%比 5.1%，p < 0.001）较低，但过度诊断率（0.5%比 0.1%，p < 0.001）较高。RR 的平均周转时间更短（51.3 比 78.8 分钟，p < 0.001）。RR 和远程放射科医生联合解读的总差异率低于 RR（5.0%比 7.7%，p < 0.001）。
与远程放射科医生相比，RR 对创伤 CT 研究的差异率更低，周转时间更快。两种阅片者的联合解读差异率更低，这表明当没有院内主治放射科医生时，这种联合解读是最佳选择。
