The value of official reinterpretation of trauma computed tomography scans from referring hospitals.
BACKGROUND
Historically, computed tomography (CT) scans of injured children obtained at referring emergency departments were not reinterpreted by trauma center radiologists at our institution, creating a dilemma for trauma physicians: rescan, use the outside interpretation, or interpret scans themselves. In 2010, our radiologists began reinterpreting all referring hospital trauma CT scans; this study examines the effect of that change.


METHODS
Transferred patients who had undergone an abdomen/pelvis CT (CTAP) scan between December 2010 and December 2012 were identified in our trauma registry. Pediatric radiologist reinterpretations were compared to referring hospital radiologist reports.


RESULTS
We identified 168 patients transferred to our institution with a CTAP. Seventy patients were excluded owing to lack of: complete study, referring hospital interpretation, or reinterpretation. Of the remaining 98 cases, 12 new injuries were identified: 3 splenic and 3 liver injuries, 1 adrenal hematoma, 2 pelvic fractures, 1 spinal fracture, 1 duodenal hematoma and 1 jejunal perforation. Three patients had solid organ injuries upgraded (grade II to III liver laceration; 2 renal lacerations with active extravasation initially missed), and 4 patients downgraded to no injury.


CONCLUSIONS
Reinterpretation of referring hospital CT scans by pediatric radiologists is beneficial to appropriate management of pediatric trauma patients with concern for blunt abdominal trauma.
Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Chinwendu
C
Onwubiko
Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA. Electronic address: David.Mooney@childrens.harvard.edu.
David P
DP
Mooney
D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015588:Observer Variation; D010360:Patient Transfer; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D012017:Referral and Consultation; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*; D055815:Young Adult
Trauma; computed tomography; radiology