Discordance of community and hospital ultrasound reports for urological abnormalities

Abstract

In Ontario, community ultrasound clinics do not require the on-site presence of a radiologist at the time of imaging. In hospitals, a radiologist is always present for this step. We compared the discrepancy rate of community and hospital ultrasound reports in a urology practice. We retrospectively reviewed the charts of patients who had abdominal ultrasound performed in the community and in the hospital between April 1, 2001 and June 30, 2005. Reports were examined for indication, findings and whether there was a discrepancy. A medical student, a resident, and a staff physician each independently reviewed the findings. One hundred and twenty-two patients had abdominal ultrasound performed in the community and were followed up with hospital imaging. Sixty-nine patients had a community ultrasound followed by hospital ultrasound, with a discordance rate of 52.2%. Fifty-three patients had a community ultrasound and then a hospital CT scan, with a discordance rate of 43.3%. Of patients with discordant ultrasound reports, 23 had an additional CT scan in which all findings were consistent with the hospital ultrasound findings. We found a very high discordance rate between community and hospital ultrasound reports. This is consistent with a study showing that the active role of the radiologist in ultrasound imaging is very important for accurate reporting. Ultrasound reports form the community in patients referred to our urology practice have a high discrepancy rate when compared with ultrasound or CT scan reports from the hospital setting. We found no discordance between ultrasound and CT scan findings from imaging performed in hospital. We recommend standardization of abdominal ultrasound imaging protocols across Canada to include the presence of a radiologist at all times.