Pediatric radiology at a rural hospital: value of teleradiology and subspecialty consultation.

Abstract

We performed a field study and subsequent laboratory investigation of pediatric radiology at a small rural hospital. Our investigation had three components: to describe the characteristics of pediatric radiology in a rural primary care facility, to test the diagnostic accuracy of interpretation of pediatric images transmitted by teleradiology, and to compare relative diagnostic accuracy of general and pediatric radiologists who interpreted pediatric images at a rural institution. All 196 pediatric radiographs obtained during a 4-month period comprised the database from which we determined practice characteristics. Reports of 153 unselected cases interpreted by general radiologists using teleradiology were compared with interpretation of the same cases by a pediatric radiologist who interpreted the original radiographs. Discrepant cases were further investigated by a receiver-operating-characteristic curve experiment in which general and pediatric radiologists interpreted each case twice: once viewing teleradiologic images and once viewing the original radiographs at another setting. We then compared interpretive accuracy of observers and techniques. The pediatric radiographs were predominantly simple examinations for common acute disease, particularly pneumonia and fractures. Discrepancies of interpretation between teleradiology and original radiographs, which occurred in 13% of images, showed no significant difference in accuracy of interpretation for either teleradiologic images or original radiographs. Likewise, we found no significant advantage for accuracy of interpretation by general or pediatric radiologists. Receiver-operating-characteristic analysis of 18 discrepant cases showed slightly increased accuracy for interpretation of original radiographs by pediatric subspecialists. Simple pediatric radiographs obtained at a rural primary care institution and transmitted by teleradiology can be adequately interpreted by general radiologists.