Department of Radiology, University of Washington, Seattle, Washington.
Department of Emergency Medicine, University of Washington, Seattle, Washington.
J Am Coll Radiol. 2022 Nov;19(11):1244-1252. doi: 10.1016/j.jacr.2022.05.031. Epub 2022 Aug 13.
Advanced imaging examinations of emergently transferred patients (ETPs) are overread to various degrees by receiving institutions. The practical clinical impact of these second opinions has not been studied in the past. The purpose of this study is to determine if emergency radiology overreads change emergency medicine decision making on ETPs in the emergency department (ED).
All CT and MRI examinations on patients transferred to a level I trauma center during calendar year 2018 were routinely overread by emergency radiologists and discrepancies with the outside report electronically flagged. All discrepant reports compared with the outside interpretations were reviewed by one of four emergency medicine physicians. Comparing the original and final reports, reviewers identified changes in patient management that could be attributed to the additional information contained in the final report. Changes in patient care were categorized as affecting ED management, disposition, follow-up, or consulting services.
Over a 12-month period, 5,834 patients were accepted in transfer. Among 5,631 CT or MRI examinations with outside reports available, 669 examinations (12%) had at least one discrepancy in the corresponding outside report. In 219 examinations (33%), ED management was changed by discrepancies noted on the final report; patient disposition was affected in 84 (13%), outpatient follow-up in 54 (8%), and selection of consulting services in 411 (61%), and ED stay was extended in 544 (81%). Discrepant findings affected decision making in 613 of 669 of examinations (92%).
Emergency radiology overreading of transferred patients' advanced imaging examinations provided actionable additional information to emergency medicine physicians in the care of 613 of 669 (92%) examinations with discrepant findings. This added value is worth the effort to design workflows to routinely overread CT and MRI examinations of ETPs.
接收机构对紧急转院患者（ETP）的高级影像学检查进行了不同程度的复查。过去，这些二次意见的实际临床影响尚未得到研究。本研究旨在确定急诊放射科对 ETP 的紧急放射学检查是否会改变急诊科（ED）的紧急医学决策。
在 2018 年的日历年内，对所有转移到一级创伤中心的患者的 CT 和 MRI 检查均由急诊放射科医生进行常规复查，并通过电子方式标记与外部报告的差异。所有与外部解释不一致的报告均由四名急诊医师之一进行审查。审查员通过比较原始报告和最终报告，确定最终报告中包含的额外信息可归因于患者管理的变化。将患者护理的变化归类为影响 ED 管理、处置、随访或咨询服务。
在 12 个月的时间内，有 5834 名患者接受了转院。在有外部报告的 5631 次 CT 或 MRI 检查中，有 669 次（12%）检查的外部报告至少有一处差异。在 219 次（33%）检查中，最终报告中指出的差异改变了 ED 管理；84 次（13%）影响患者处置，54 次（8%）影响门诊随访，411 次（61%）影响咨询服务选择，544 次（81%）影响 ED 住院时间延长。在 669 次（92%）有差异的检查中，有 613 次检查的不同发现影响了决策。
对转院患者的高级影像学检查进行急诊放射科复查，为急诊科医师提供了可操作的额外信息，对 669 次（92%）有差异发现的检查做出了决策。这种附加值值得努力设计工作流程，以常规复查 ETP 的 CT 和 MRI 检查。
