Quality assurance of neuroradiology in a District General Hospital.
BACKGROUND
An increasing number of neurologists in District General Hospitals (DGHs) rely on local neuroimaging reports from general radiologists.


OBJECTIVE
To determine the level of disagreement between general radiologists and neuroradiologists in reporting neuroimaging from patients referred to a neurologist.


METHODS
Prospective observational study.


METHODS
We studied 232 patients referred for a neuroradiologist's report on neuroimaging over a 17-month period. Pre-planned comparisons included primary and secondary report findings, length of report and suggestions for additional investigations.


RESULTS
Of the 593 patients assessed during the study period, a neuroradiologist's report was sought for 232 (39%): 119 men, 113 women, mean age 46.1 (SD 17.6) years. Primary findings differed in 37 patients (15.9%) (95%CI 11.5-21.3). Reports from neuroradiologists changed subsequent management in 31 (13.4%) (95%CI 9.3-18.4). Differences in secondary findings occurred in 52 (22.4%) (95%CI 17.2-28.3), and differences in either primary or secondary outcomes in 77 (33.2%) (95%CI 27.2-39.6). The level of disagreement in primary findings was as frequent among patients investigated with magnetic resonance imaging as among computerized tomogram-only patients (p = 0.13). Neuroradiologists recommended additional investigations for 24 patients (10.3%) (95%CI 6.7-15.0) and provided longer reports than general radiologists (p < 0.001).


CONCLUSIONS
Neuroimaging reports of some patients differ substantially between general radiologists and neuroradiologists. Optimal management of neurological patients in DGHs may require timely access to neuroradiologists.
Altnagelvin Neurological Centre, Altnagelvin Hospital, Londonderry BT47 6SB, UK. markmccarron@doctors.org.uk
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D003937:Diagnosis, Differential; D005260:Female; D006767:Hospitals, District; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards*; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis*; D009462:Neurology / Q000592:standards; D009485:Neuroradiography / Q000592:standards*; D009660:Northern Ireland; D015588:Observer Variation; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D011871:Radiology / Q000592:standards; D014057:Tomography, X-Ray Computed / Q000592:standards