Accuracy of Radiology Trainee Major Trauma CT Reports C Bowles, IE Tribe, S Ameli-Renani, G Goh, R Greenhalgh St George’s Hospital, London

Background

In the radiological assessment of poly-

traumatized patients, reports must be

both timely and accurate, as any

misinterpretation can adversely impact

on patient management. The

complexities of injuries within this group

combined with the large volume of data

on each scan, adds to the challenge of

reporting. As such, the accuracy of the

trainees is important to monitor to ensure

continued patient safety and good quality

care.

In our level 1 trauma centre radiology

trainees play an important role in the

reporting of trauma scans and are

usually first to provide a provisional

report in the on-call setting. Provisional

reports are then followed by a

consultant’s final report within 24 hours.

Standards

References

Previous studies have shown rates of

consultant amendment of discrepancies

ranging from 17-24% of scans, with major

amendments from 5-10% (Hillier et al

(2003), Briggs et al (2010), Terreblanche

et al (2011)).

CYCLE TWO- POST INTRODUCTION OF

PRIMARY ASSESSMENT PROFORMA

Of 622 patients, 293 (37%) had major or

minor injuries, and 382 (63%) had no

identifiable injury or incidental findings only.

Of 591 scans provisionally reported by

trainees, 117 (19.8%) were amended on

consultant review. Of these, 73 (12.4%) had

no impact on patient management, 39

(6.6%) had minor impact, and 5 (0.8%) had

major impact. The rate of discrepancy was

significantly lower in senior registrars than in

junior registrars (p<0.005)

Results

CYCLE ONE- PRE INTRODUCTION OF

PRIMARY ASSESSMENT PROFORMA

Of 315 scans provisionally reported by

trainees, 207 (67%) had major or minor

injuries, and 108 (33%) had no identifiable

injury or incidental findings only. 88 (41%)

were amended on consultant review. Of

these, 36 (17%) had no impact on patient

management, 49 (23%) had minor impact,

and 3 (0.1%) had major impact. The rate of

discrepancy was not significantly different in

senior registrars compared to junior

registrars (p=0.11)

Methodology

We retrospectively reviewed all major

trauma CT scans, comparing provisional

registrar reports with the final Consultant

report, for the 6-month period April- Sept

2011. A trauma primary assessment

proforma was introduced in December

2011. A year later, April-Sept 2012, a

second cycle of the audit was performed.

Reports were classified according to their

findings. These included major injury,

minor injury, incidental findings or no

identifiable injury.

All provisional reports were subsequently

checked by a consultant radiologist within

24 hours. Discrepancies between reports

were noted and classified as follows:

-No impact on initial management.

-Minor: defined as a discrepancy which

requires non-immediate effect to patients’

management within 24 hours.

-Major: defined as a discrepancy which

requires immediate change to patients’

management within 24 hours, as may have

life or limb threatening consequences to

the patient’s health.

.

Discussion

The second cycle of audit, after introduction

of a trauma primary assessment proforma,

showed rates of consultant amendment

comparable to or better than previously

published studies, an improvement on the

first cycle. 43% of registrar provisional

reports were amended on the first cycle,

down to 20% on the second cycle.

Conclusion

Introduction of a primary assessment

proforma gives the trauma team essential

information to manage life threatening

injuries and allows the reporting radiologist

“space” to give a primary report leading to

fewer discrepancies between trainee and

consultant reports.

Trainees reporting major trauma scans is

safe and an important part of radiology

training

Hillier JC et al. Trainee reporting of computed

tomography examinations: do they make mistakes and

does it matter? Clin Radiol 2004;59:159–62

Briggs, RH et al. Provisional reporting of polytrauma CT

by on-call radiology registrars. Is it safe? Clin Radiol

2010;65:616-622

Terreblanche OD et al. Should registrars be reporting

after-hours CT scans? A calculation of error rate and the

influencing factors in South Africa. Acta Radiol

2012;53(1):61-8.

17%

23%

0.10%

12.40%

6.60%

0.80%

0%

5%

10%

15%

20%

25%

No impact on management

Minor Impact Major Impact

Discrepancy rate in provisional Registrar reports compared with

Consultant reports

Cycle 1

Cycle 2