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

American Surgeon - Tập 67 Số 12 - Trang 1175-1177 - 2001
George C. Velmahos1, C Fili1, Pantelis Vassiliu1, Nicolaos Nicolaou1, Randal Radin2, Alison Wilcox2
1Departments of Surgery and Radiology, University of Southern California Keck School of Medicine and the
2Los Angeles County and University of Southern California Medical Center, Los Angeles, California

Tóm tắt

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.

Từ khóa


Tài liệu tham khảo

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Thông tin
Thông tin xuất bản

American Surgeon

Tập 67 Số 12

1175-1177

Thông tin tác giả