87 Emergency Radiology Overreads Change Management of Transferred Patients With Traumatic Injuries

Abstract

When patients are transferred to another emergency department (ED) for higher level of care, the radiology studies are often not reviewed by dedicated emergency radiologists. At our Level 1 trauma center, which serves as a tertiary referral center for 5 states, emergency radiologists overread the computed tomography (CT) and magnetic resonance imaging (MRI) studies of patients who are transferred to our center. These overreads provide additional information regarding traumatic injuries that may not have been identified in the initial imaging report. The effect of these overreads by emergency radiology has not been studied before. The purpose of this study is to evaluate the effect of trauma management by an emergency physician (EP) as a result of radiology overreads performed by an emergency radiologist. We performed a review of all CT and MRI studies for patients transferred to our Level 1 trauma center during the year 2018. We selected imaging studies that when reviewed by an emergency radiologist, had discrepancies when compared to the initial interpretation. Of these studies with different interpretations, we selected those of patients with traumatic injuries. These studies were subsequently reviewed by an EP and the effect on patient care was assessed. The changes in care included clinical management (ie, allocation of resources, additional procedures), consulting services requested, change in disposition and patient follow-up. During the year 2018 there were 2847 patients transferred to our Level 1 trauma center. These patients had a combined 6259 CT and MRI studies performed prior to transfer to our ED. Of these studies, 669 discrepancies between the initial radiology interpretation and the emergency radiologist interpretation were identified. 551 (82%) of these radiology studies were for the evaluation of traumatic injuries. 503 (91%) of this subset had discrepancies identified on the final overread by the emergency radiologist that effected the EP's management. The most common areas in which management was altered were; 446 (81%) resulted in a longer ED stay; 341 (62%) required further consultation with another specialist service; 189 (34%) resulted in alteration of ED-specific management (ie, additional imaging ordered, change in level of resource, spinal precautions). A workflow where advanced imaging studies are overread by emergency radiology adds value to patient care, specifically in trauma. This additional information directly affects patient care and the emergency physician’s management of patients with traumatic injuries.