24-hour peer review of initial trauma radiographs does not change diagnosis and management of moderate and severely injured trauma patients

Anthony Kopatsis, Jeffrey M. Nicastro, Michael R. Castellano, Cheryl A. Fields, Joseph Lowry, Aurel C. Cemaianu, Gene F. Coppa

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Our New York State designated level one trauma center has attending radiologists available 24 hours a day to render immediate ("soft-reading") interpretations of emergent radiologic studies. Apparent change in "official" radiology interpretations, dictated several days following these so-called "soft-readings", had been cause for concern within our trauma system. In an attempt to define whether a quality improvement issue existed, we established a mandatory "next-day" independent review session for all trauma radiologic studies. We then compared initial and next-day interpretations for discrepancies. Methods: 864 consecutive radiographic studies from 253 moderate to severely injured (based upon local triage protocol) trauma patients were revewed the day following presentation by one of five "senior" attending radiologists. Comparison was made with the original interpretation and all discrepancies recorded. Age, sex, hemodynamic status, injury severity scores, and revised trauma scores were also recorded. Results: We examined 253 consecutive patients with a total of 864 studies. Mean age was 35.6 (± 20 yrs), mean injury severity score 7.8 (± 7), and mean revised trauma score was 12.2 (± 1.2). There were no differences in radiographic readings at 24-hours post "soft- reading". There was consequently no change in patients' clinical management as a result of secondary reading. Conclusion: Radiographic interpretations performed on moderate and/or severely injured trauma patients by unselected attending radiologists are reliable. Re-review by "senior" attending radiologists in our experience did not result in any alteration in diagnosis or treatment. A policy of "re-review" of initial trauma radiograph interpretations, while certainly a useful resident education tool, were neither necessary nor cost effective in our institution.

Original languageEnglish
Pages (from-to)A150
JournalCritical Care Medicine
Volume27
Issue number12 SUPPL.
DOIs
StatePublished - 1999
Externally publishedYes

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