Pediatric radiologists skillfully read emergency breast ultrasound—but patients may shrug off discharge instructions
Pediatric radiologists working the ED are no less proficient than breast imaging subspecialists at providing initial ultrasound-based diagnoses of, and care recommendations for, breast-related symptoms in young patients.
However, pediatric breast patients are significantly less inclined to adhere to follow-up instructions coming from emergency diagnosticians.
For this reason, these patients may need pointed guidance upon ED discharge lest cancers go undetected in early stages.
So conclude Johns Hopkins researchers who made the comparison because it’s not uncommon for pediatric patients with breast complaints to first present in the ED and receive ultrasound imaging.
Corresponding author Emily Dunn, MD, and colleagues had their work published online Aug. 16 in Emergency Radiology [1].
The team reviewed the cases of 75 pediatric patients, mean age 13 ± 5.6 years, who had breast ultrasound in the emergency department over a six-year period ending in December 2019.
Over the course of those years, 12 pediatric radiologists interpreted the exams. Their experience ranged from one to 33 years.
For the study, the researchers had three breast imaging specialists interpret the same 75 scans, assigning BI-RADS scores and making treatment recommendations as they went.
Apart from the images, the breast radiologists only had patient age and ultrasound indication to work with.
Agreement Between Pediatric Radiologists and Seasoned Breast Specialist: Moderate
To establish the ground truth diagnosis for each case, Dunn and co-researchers used patient clinical outcomes, unanimous consensus among all three breast imaging radiologists or, when there was no such consensus, the treatment recommendation of the most experienced breast subspecialist.
The authors report a moderate agreement in management recommendations (k = 0.54) between the pediatric rads and the most experienced breast imager.
They found no significant difference in recommendations for further management between pediatric radiologists (22 of 75, or 29.3%) and the most experienced breast imaging radiologist (15 of 75, or 20.0%).
Notably, one patient had a malignancy and was given appropriate instructions by the pediatric radiologists: Report for further evaluation at the institution’s breast clinic.
However, the majority of patients referred to the breast clinic, 15 out of 22 (68%), went untracked after leaving the ED.
‘All Children Are at Risk for Poor Adherence’
In their discussion Dunn and co-authors conclude that initial evaluation of pediatric breast complaints “can be adequately interpreted by pediatric radiologists in the emergency setting without missing suspicious lesions.”
At the same time, the team underscores, the evident lack of consistent follow-up for breast patients after leaving the ED with specific instructions suggests the need for a more proactive stance by pediatric radiologists reading breast ultrasounds in emergency settings.
The aim of any such strategy, they add, should be to “reduce the likelihood of a missed or delayed cancer diagnosis.”
Citing previous research showing poor patient adherence to ED discharge instructions, Dunn et al. comment:
All children, regardless of sociodemographic characteristics, are at risk for poor adherence, and interventions aimed at improving patient follow up after [ED] discharge are necessary.”
The study is posted in full for free.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.