CTs of Transferred ED Patients May Have Interpretation Discordance

Routine over-reading of pre-transfer CT scans may be justified due to the substantial likelihood of a major discordance in interpretation that may impact the clinical management of patients, according to a study presented at RSNA 2016.

Researchers from Seattle, WA, performed a retrospective study to determine the concordance rate of CT interpretations of emergently transferred patients to a Level I trauma center. They reviewed outside CT scans of all adult patients who were transferred to the emergency department of a Level I trauma center from May 9, 2015 to June 9, 2015. A total of 628 scans from 327 transfers were reviewed. The patients were categorized as trauma or non-trauma transfers. The original imaging report was compared to the reviewer’s findings, and categorized as concordant or discordant. Discordant findings were rated as minor, moderate, or major. Major discordances were defined as having the potential to impact clinical management. Rates of each type of discordance and 95% confidence intervals (CIs) were calculated per transfer and per exam.

The results showed that there were 213 (65%) trauma transfers and 114 (35%) non-trauma transfers, corresponding to 490 trauma-related exams and 138 non-trauma exams.  Of the 327 total transfers, there were 119 (36%) with any discordance and 56 (17%) with at least one major discordance. These major discordances were identified in 49 (23%) of the 213 trauma transfers and seven (6.1%) of the non-trauma transfers.

On a per exam basis, 59 of 628 (9.4%) total exams had a major discordance. There were 51 (10%) major discordances among the trauma-related exams and eight (5.8%) among the non-trauma exams.

The researchers concluded that there were major interpretive discrepancies in the CT scans of 17% of patients emergently transferred to a Level I trauma center, and that trauma transfer patients were significantly more likely to have a major discordance than non-trauma transfer patients.