Significant variability found in pediatric CT imaging interpretations
There often is a significant amount of discordance between pediatric CT interpretations completed by general radiologists versus pediatric readers, sometimes leading to delays or changes in treatment.
In fact, as many as 63% of exams specific to pediatric imaging have differing interpretations that result in major care modifications, according to new data published in the Journal of Pediatric Surgery. This issue is the result of many regions lacking access to pediatric trauma centers, which forces families to seek care at adult hospitals that may not have pediatric radiologists on staff, authors of the paper noted.
“In the United States, only 3% of radiologists are subspecialized in pediatrics and are predominantly concentrated in academic centers and metropolitan areas. As a result, children with trauma-related injuries are frequently transferred to pediatric trauma centers after undergoing initial imaging interpreted by general or adult radiologists,” Robert A. Swendiman MD, from Primary Children’s Hospital, Intermountain Health, Salt Lake City, and colleagues explained. “To address potential variability, it is common practice at many pediatric centers to secondarily review outside imaging by fellowship-trained pediatric radiologists.”
The authors’ organization specializes in pediatric trauma care; its policies require radiologists who specialize in pediatrics to perform a second read for patients transferred from outside facilities. Recently, the group investigated how often their readers’ interpretations differed from those of the initial reports. The team reviewed the cases of patients who were transferred during a period of two years, taking note of their reason for referral, initial diagnosis, exam type and any treatment changes that occurred due to discordance between imaging interpretations.
Of the nearly 1,200 CT scans included in the analysis, there was an overall discordance rate of 16%. However, certain exams were more susceptible to being interpreted differently; CTs of the abdomen and pelvis had the highest discordance rate, at 25%, which resulted in the second highest rate of major treatment changes, at 38%. CT scans of the cervical spine yielded the highest rate of major treatment changes, at 63%.
Just 13 of the differing interpretations would have changed transfer-related decisions, the group noted. Of those, 11 were reports on CT exams of the head.
“The misses on outside reads can have significant consequences, as shown by the rate of major treatment changes caused by the findings on the overreads,” the authors cautioned. “However, none of these disagreements would have resulted in a transfer decision change when accounting for the child’s other injuries. Therefore, postponing a transfer while awaiting an overread is likely unwarranted.”
These findings support the practice of overreads by pediatric radiologists when children are being transferred from adult hospitals, the group advised.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.