Okay, one of your referring hospitals has just transferred a patient to you. They diligently filled out the transfer checklist and made sure to either push the images to your PACS system or include a CD containing the imaging that they performed. For good measure, they also included a copy of the radiology report for those images.
Now what do you do?
- Read the report and consider the results
- Look at the images yourself and make decisions
- Have your friendly neighborhood radiologist re-read the images and produce a new report
Correct answer: all of the above. But why? First, you can get a quick idea of what another professional thought about the images, which may help you think about the decisions you need to make.
And one of the few dogmas that I preach is: “read the images yourself!” You have the benefit of knowing the clinical details of your patient, which the outside radiologist did not. This may allow you to see things that they didn’t because they don’t have the same clinical suspicion. Besides, read the images often enough and you will get fairly good at it!
But why trouble your own radiologist to take a look? Isn’t it a waste of their time? Boston Children’s Hospital examined this practice in the context of taking care of pediatric trauma patients. This hospital accepts children from six hospitals in the New England states. In 2010, they made a policy change that mandated all outside images be reinterpreted once the patient arrived. They were interested in determining how often there were new or changed diagnoses, and what the clinical impact was to the patient. They focused their attention only on CT scans of the abdomen and pelvis performed at the referring hospital.
Here are the factoids:
- 168 patients were identified over a 2-year period. 70 were excluded because there was no report from the outside hospital (!), and 2 did not include the pelvis.
- Reinterpretation in 28% of studies differed from the original report (!!)
- Newly identified injuries were noted in 12 patients, and included 7 solid organ injuries, 3 fractures, an adrenal hematoma, and a bowel injury. Three solid organ injuries had been undergraded.
- Four patients with images interpreted as showing injury were re-read as normal
- Twenty of the changed interpretations would have changed management
Bottom line: Reinterpretation of images obtained at the outside hospital is essential. Although this study was couched as pediatric research, the average age was 12 with an upper limit of 17. Many were teens with adult physiology and anatomy. There will be logistical hurdles that must be addressed in order to get buy-in from your radiologists, such as how they can get paid. But the critical additional clinical information obtained may change therapy in a significant number of cases.
Reference: The value of official reinterpretation of trauma computed tomography scans from referring hospitals. J Ped Surg 51:486-489, 2016.