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C Ball, SpR Radiology, Portsmouth Hospitals NHS Trust

National Audit of the Accuracy of Interpretation of Emergency Abdominal CT in Adult Patients Who Present with Non-Traumatic Abdominal Pain. C Ball, SpR Radiology, Portsmouth Hospitals NHS Trust A Higginson, Consultant Radiologist, Portsmouth Hospitals NHS Trust

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C Ball, SpR Radiology, Portsmouth Hospitals NHS Trust

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  1. National Audit of the Accuracy of Interpretation of Emergency Abdominal CT in Adult Patients Who Present with Non-Traumatic Abdominal Pain

  2. C Ball, SpR Radiology, Portsmouth Hospitals NHS Trust A Higginson, Consultant Radiologist, Portsmouth Hospitals NHS Trust K Drinkwater, Audit Officer, Royal college of Radiologists D Howlett, Consultant Radiologist, East Sussex Hospitals NHS Trust

  3. In collaboration with the RCR audit committee. Special thanks to all the audit leads and those who completed the audit.

  4. Plan • Background • Aims • Method • Results • Discussion/The future

  5. Background • The NHS is experiencing a period of change with reconfiguration of local services and increasing use of outsourced reporting to external organisations to meet demand and to generate cost savings. • National drive to improve quality with a strong focus on patient safety. • The quality of the report must remain high whether generated by trainee radiologists, consultant trust radiologists or consultant non-trust radiologists.

  6. Aims • To assess major/minor discrepancy rates for provisional and addendum reports • Assess the impact of discrepancies • To evaluate correlation of provisional +/- addendum report and CT auditor report with laparotomy findings in a surgical group.

  7. Coding • Major Discrepancy – a change or potential change in diagnosis or treatment as a result of addendum/CT auditor review. • Minor Discrepancy – minor differences between provisional/addendum and addendum/auditor reports, unlikely to result in a significant change in patient management. • Indeterminate report – a report where a wide, or non-specific, or inappropriate differential diagnosis is given which leads to indeterminate management advice. These reports will be treated as major discrepancies.

  8. Standards

  9. Methods • All centres across the UK with acute abdominal CT reporting capacity were included • Retrospective identification from 1/1/2013 onwards from the radiology departmental database of 50 consecutive non-traumatic adult (>16 years) emergency patients who had out of hours (6pm – 8am) abdominal/abdominopelvic CT

  10. Split cases into: • Non-surgically managed patients • Surgically managed patients • Non-Surgical Group –Abdominal/abdominopelvic CT but no laparotomy subsequent to the CT. • Patients who had another intervention during this admission subsequent to the CT (e.g. Colonic/JJ stent, EVAR, percutaneous drainage, laparoscopy) would be included in this category.

  11. Surgical Group - 25 consecutive adult patients who underwent a laparotomy as an emergency for an acute abdomen (non-traumatic) and who also underwent emergency abdominal/abdominopelvic CT out of hours as part of their assessment • The laparotomy may have been performed at any time following the CT if deemed relevant to the CT diagnosis

  12. Results - Respondents

  13. Results - Institution

  14. Results – On call reporting by SpR

  15. Results – On call reporting by Offsite radiologist

  16. Standards SpR discrepancy rates Consultant (on and offsite) discrepancy rates

  17. Non-surgical Discrepancies

  18. Standards met…? Yes

  19. Results – Surgical Discrepancies

  20. Standards met…? Yes

  21. Standards Correlation with laparotomy

  22. Results – Correlation with laparotomy

  23. Standards met…? Yes (Almost)

  24. Results – Non surgical Discrepancies

  25. Results – Surgical Discrepancies

  26. Discussion • Standards met for the majority of the parameters measured/analysed so far • If discrepancies – usually a delay in treatment/surgery is the result however the impact of this/unnecessary treatment on patient outcome must be appreciated

  27. Still a lot of data to sort through… • What were the discrepant cases – ischaemic bowel? Localised perforation? • Splitting of on and offsite radiologists and SpRreports with consultant input

  28. References • CT and appendicitis: evaluation of correlation between CT diagnosis and pathological diagnosis; Andre J et al; Postgraduate medical journal; 2008; 84; 321-324 • Discrepancies in interpretation of ED body CT scan reports by radiology residents; N Tieng et al; American journal of emergency medicine; 2007; 25; 45-48 • Evaluating the acute interpretation of emergency medicine resident interpretations of abdominal CTs in patients with non-traumatic abdominal pain; Ju Kang et al; Journal of Korean medical science; 2012; 27; 1255-1266

  29. The DEPICTORS study; Discrepancies in preliminary interpretations of CT scans between on call residents and staff; J Walls et al; Emergency radiology; 2009; 16; 303-308 • Overnight resident preliminary interpretations on CT examinations; Should the process continue? Strub et al; Emergency radiology; 2006; 13; 19-23

  30. Questions please…

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