Quality Outcomes of Reinterpretation of Brain CT Studies by Subspecialty Experts in Stroke Imaging

Jordan, Yusef J.; Jordan, John E.; Lightfoote, Johnson B.; Ragland, Karen D.

doi:10.2214/ajr.11.8358

Cited by 21 publications

(18 citation statements)

References 18 publications

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“…The usual appearance is central low attenuation with peripheral enhancement representing preserved adrenal tissue (8). The bleed continues to expand giving the gland an oval or round configuration.…”

Section: Discussionmentioning

confidence: 99%

Bilateral adrenal gland haemorrhage: an unusual cause

Gowda

Shenoy

Malabu

et al. 2014

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryOur patient had drainage of a large amoebic liver abscess. This got complicated by a severe degree of hypotension, which required aggressive fluid resuscitation and hydrocortisone support. Computerised tomography (CT) of the abdomen revealed bilateral adrenal gland haemorrhage (BAH) resulting in primary adrenal gland failure, which was the cause for hypotension. Patient was on long-term warfarin for provoked deep vein thrombosis of lower limb, which was discontinued before the procedure. Thrombophilia profile indicated the presence of lupus anticoagulant factor with prolonged activated partial thromboplastin time (aPTT). Patient was discharged on lifelong warfarin. This case emphasises the need for strong clinical suspicion for diagnosing BAH, rare but life-threatening condition, and its association with amoebic liver abscess and anti-phospholipid antibody syndrome (APLS).Learning points Recognition of BAH as a rare complication of sepsis.APLS can rarely cause BAH.

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Section: Discussionmentioning

confidence: 99%

Bilateral adrenal gland haemorrhage: an unusual cause

Gowda

Shenoy

Malabu

et al. 2014

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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“…In the adult population, the reported discrepancy rate between radiologic interpretations performed at primary facilities and those performed at tertiary care referral centers ranges from 12% to 41% [1][2][3][4][5]; in comparisons limited to general radiologists versus subspecialty neuroradiologists, the reported discrepancy rate ranges from 1.3% to 34% [6][7][8]. However, to our knowledge, the rate and type of discrepancies related to subspecialty reinterpretations of radiologic studies are not known in pediatric patients.…”

Section: Second Opinion Interpretations By Specialty Radiologistsmentioning

confidence: 99%

“…However, interpretation of outside studies represents a substantive additional workload for specialty radiologists at a referral center, one of which is currently underrecognized and largely unfunded [9]. Discrepancy rates currently reported in the literature cover a relatively wide spectrum, between 1.3% and 41% [1][2][3][4][5][6][7][8]; this large range of rates likely reflects the variability in the groups examined by the various investigators: from comparisons of radiologists and subspecialists within the same group to comparisons of interpretations among biopsy-proven subspecialty patients. Our reported discrepancy rates reflect the rates of discrepancy at a children's hospital and compare interpretations made at the referring institutions with those of experienced specialty radiologists at a tertiary care children's hospital in an unselected pediatric population.…”

Section: Second Opinion Interpretations By Specialty Radiologistsmentioning

confidence: 99%

Second Opinion Interpretations by Specialty Radiologists at a Pediatric Hospital: Rate of Disagreement and Clinical Implications

Eakins

Ellis

Pruthi

et al. 2012

American Journal of Roentgenology

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Our findings suggest that discrepancy rates for second interpretations in studies of pediatric patients transferred to tertiary care pediatric institutions are substantial. Although the original and second interpretations in the majority of cases were in agreement, major discrepancies were prevalent--12.6% and 32.6% of neuroimaging and body studies, respectively--and the second interpretations were significantly correlated with the final diagnosis. These results indicate that interpretations by subspecialty radiologists at a point-of-care facility provide important clinical information about the pediatric patient and should be recognized by payers as integral to optimal care.

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“…The potential impact of double reporting relates to the discordance level between the first and second observer and this has been shown to vary between studies. Two American studies evaluating a total of 1641 cranial CT examinations produced by general radiologists with those generated by neuroradiologists revealed a rate of discordance between reports of 1.3–2.5%, suggesting that discordance between the general radiologist and neuroradiologist is uncommon in this setting . This is in contrast to a study involving 218 patients comparing the diagnostic accuracy of neuroradiologists with radiology residents when interpreting emergency cranial CT examinations, which found a mean rate of 15% discordance between the two groups .…”

Section: Discussionmentioning

confidence: 87%

Evaluation of the effect of double reporting on test accuracy in screening and diagnostic imaging studies: A review of the evidence

2016

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Diagnostic error in radiology is not uncommon, with rates of clinically significant error reported to be as high as 20%. Radiological errors are often multifactorial, however, perceptual factors are thought to be mainly responsible. One way of reducing perceptual error is that of double reporting, which refers to the interpretation of radiological investigations by two observers, with strategies of arbitration and consensus available to settle discordant reports. Independent double reporting, where observers have no knowledge of each other's reports, is generally considered to be the most effective form. The impact of double reporting on diagnostic efficacy has been primarily explored in screening mammography, where it has consistently been shown to improve sensitivity, cancer detection rate and depending on local policy, have a positive influence on recall rates. Subsequently, the adoption of double reporting is reported as standard practice in many national and regional breast cancerscreening programmes. To a lesser extent, the impact of double reporting has also been investigated for neuroradiology, thoracic and gastrointestinal imaging, with small-scale studies in these fields showing promising results. With the widespread implementation of digitisation and the ease of access to images, the efficacy and cost-effectiveness of double reporting for other common radiological investigations requires attention. The review will evaluate the evidence regarding the effect of double interpretation of diagnostic imaging studies on test accuracy.

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Quality Outcomes of Reinterpretation of Brain CT Studies by Subspecialty Experts in Stroke Imaging

Cited by 21 publications

References 18 publications

Bilateral adrenal gland haemorrhage: an unusual cause

Bilateral adrenal gland haemorrhage: an unusual cause

Second Opinion Interpretations by Specialty Radiologists at a Pediatric Hospital: Rate of Disagreement and Clinical Implications

Evaluation of the effect of double reporting on test accuracy in screening and diagnostic imaging studies: A review of the evidence

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