Around-the-Clock Attending Radiology Coverage is Essential to Avoid Mistakes in the Care of Trauma Patients

Velmahos, George C.; Fill, Cleo; Vassiliu, Pantelis; Nicolaou, Nicolaos; Radin, Randal; Wilcox, Alison
December 2001
American Surgeon;Dec2001, Vol. 67 Issue 12, p1175
Academic Journal
Financial constraints due to increasing operating cost and decreased reimbursement do not allow many hospitals to maintain coverage by attending radiologists around the clock (CARAC). Preliminary film readings by radiology trainees may be inaccurate. In trauma, decisions are made fast and are often based on these preliminary readings. To examine whether there are significant discrepancies between preliminary readings (PRs) and final readings (FRs) of CT scans of trauma patients we prospectively recorded PRs (done immediately by radiology residents) and FRs (done the following working day by radiology attendings) over a period of 6 months for trauma CT scans done between 5 PM and 7 AM on weekdays or weekends. A discrepancy was classified as significant if a change in management was instituted after FR. In 42 of 383 (11%) trauma patients there was a discrepancy between PR and FR. Patients with discrepancies had a higher Injury Severity Score, higher incidence of penetrating trauma, longer hospital stay, higher hospital charges, and higher mortality than patients without any discrepancy. Most of the discrepancies were found on abdominal CT scans. The lower the level of radiology resident doing the PR the higher the likelihood of a discrepancy. In 20 patients (5%) a significant discrepancy was found. We conclude that the absence of CARAC results in inaccurate FRs risking optimal trauma patient care. The institutional savings realized by avoiding CARAC may be offset by the cost of additional care provided to patients who have delayed diagnosis and treatment due to the lack of it.


Related Articles

  • Trauma Computed Tomography: Benefits and Hazards. Paydar, Shahram; Dalfardi, Behnam // World Journal of Surgery;Oct2014, Vol. 38 Issue 10, p2735 

    A letter to the editor is presented in response to an article about trauma computed tomography, by Sierink and colleagues, published in the April 2014 issue.

  • Study notes SPECT-CT as influential in making talar lesion treatment decisions. Brockenbrough, Gina // Orthopedics Today;Nov2009, Vol. 29 Issue 11, p42 

    This article discusses research being done on single-photon emission computed tomography (SPECT-CT) as a diagnostic tool for osteochondral lesions (OCL) of the talus.

  • Effects of Computerized tomography scan features on outcome of traumatic brain injuries. Nnadi, M. O. N.; Bankole, O. B.; Fente, B. G.; Ikpeme, A. A. // East & Central African Journal of Surgery;Mar/Apr2015, Vol. 20 Issue 1, p132 

    Background: Computerized tomography (CT) scan is the image modality of choice in acute traumatic brain injuries. It helps in identifying urgent surgical emergency lesions. We assessed the effect of computerized Tomography scan features on the functional outcome of traumatic brain injury patients...

  • Use of computed tomographic scanning and embolization to improve the nonoperative management of splenic trauma: critically appraised topic. Elliott, James A.; Millward, Steven F.; Kribs, Stewart W. // Canadian Association of Radiologists Journal;Jun2003, Vol. 54 Issue 3, p183 

    Discusses the use of computed tomographic (CT) scanning and embolization to improve the nonoperative management (NOM) of plenic trauma. Patient profile; Indication that a traumatic splenic vascular abnormality on CT is a strong predictor of NOM failure in patients with blunt splenic injuries.

  • Multi-detector computed tomography findings of atypical blunt traumatic aortic injuries: a pictorial review. Scott Steenburg; James Ravenel // Emergency Radiology;Jul2007, Vol. 14 Issue 3, p143 

    Abstract  Traumatic injuries to the aorta are a significant source of morbidity and mortality in trauma patients, which highlights the importance of rapid diagnosis and treatment. Multi-detector row computed tomography has become the primary imaging modality for the imaging...

  • Acute Kidney Injury Risk in Trauma Patients Linked to Excessive Body Fat. FREI, ROSEMARY // Renal & Urology News;Apr2013, Vol. 12 Issue 4, p24 

    The article reports on the study which found an increased risk of acute kidney injury (AKI) in patients with large amounts of visceral or subcutaneous abdominal adiposity on computed tomography (CT) scans.

  • periportal tracking.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p1753 

    An encyclopedia entry for "periportal tracking," which refers to the finding of decreased computerized tomographic attenuation around the portal region of the liver during the evaluation of patients with abdominal injuries, is presented.

  • Case report on the successful removal of an organic penetrating object into the orbit. Rezae, Leyla; Najafi, Farid; Moradinazar, Mehdi; Ahmadijouybari, Tooraj // Journal of Injury & Violence Research;Jan2014, Vol. 6 Issue 1, p50 

    The penetration of objects into the orbit can lead to blindness and even to the death of the patient. The penetration of organic objects longer than 7cm into the eye is a rare phenomenon. In this study, we report a case in which a 6-year-old boy fell on a pencil which penetrated the upper side...

  • Emergency Pediatric Imaging Quiz - Case 1. Spyridopoulos, T. N.; Sakellaropoulos, A.; Bourikas, D.; Dagla, T.; Stratigopoulou, A.; Anagnostaki, E.; Evlogias, N. // Archives of Hellenic Medicine / Arheia Ellenikes Iatrikes;2014, Vol. 31 Issue 2, p250 

    The article presents a quiz related to computed tomography (CT) and the author's views on CT and spleen injury.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics