Discrepancies between community interpretations and emergency radiology re-interpretation of imaging exams on trauma patients transferred to a level 1 trauma center.

purposeTo evaluate the rate of discrepancies between community radiologists’ interpretations of trauma studies and those of the emergency radiologists at an academic level 1 trauma center and to assess the impact on patient management provided by emergency radiologist overreads.

methodsA search of our institutional Radiology Information System (RIS) was performed to find outside overread interpretations that were performed by emergency radiologists at our institution in a 1-year period (January 1, 2023-December 31, 2023). For these patients, the outside report was obtained and compared to the emergency radiologist overread report. Discrepancies between reports were divided into major and minor discrepancies. A major discrepancy was defined as a change in interpretation that resulted in altered patient management (including interventional radiology procedure or surgery). A minor discrepancy was defined as a change in interpretation that did not alter patient management.

resultsThe study cohort consisted of 301 imaging exams performed on 135 patients. The mean age was 52.3 years (range 19–97 years), included 68 males (63.7%), and a mean Injury Severity Score (ISS) of 13 (range 1–51). Patients were transferred from 29 different facilities from around our state. The most common mechanism of injury was fall (n = 128, 42.5%) followed by motor vehicle collisions (MVC, n = 103, 34.2%) and assaults (n = 25, 8.3%). Major discrepancies were found in 26 exams (8.6%) affecting 25 patients (18.5%), of which 7 required surgery or an interventional radiology procedure. Minor discrepancies were found in 49 exams (16.3%) affecting 42 patients (31.1%). In total, some discrepancy was found in 75 (24.9%) of exams affecting 62 patients (49.6%). There is a statistically significant association with a discrepancy following MVC compared to the other mechanisms of injury (p = 0.0228).

conclusionsWe found that nearly a quarter (24.9%) of overread imaging exams affecting nearly half (49.6%) of transferred trauma patients had a discrepancy in the original report, resulting in a change in management in 18.5% of patients, with over a quarter (26.9%) of major discrepancies requiring surgery or interventional radiology procedures. Motor vehicle collisions were associated with an increased likelihood of a discrepancy. Our findings continue to support the value of reinterpretation of outside imaging exams by dedicated emergency radiologists in the setting of trauma.