The Quality of Surgical Resident Interpretation of After-Hour CT Scans of the Head and Abdomen in Trauma

Computed tomography (CT) is an important diagnostic tool in the evaluation of trauma patients. Accurate interpretation of CT scans remains critical in decision-making and the resultant quality of care. In our study, the records of a consecutive cohort of trauma patients who underwent after-hour CT scans of the head and abdomen between January 23 and June 30, 2004, at Kern Medical Center were reviewed. Three hundred thirty-five CT studies were collected in 211 patients. The accuracy of resident interpretation was 92.8 per cent for abdominal and 97.5 per cent for head CT. Resident readings were 93.2 per cent sensitive and 95.4 per cent specific with a positive predictive value of 85.2 per cent and a negative predictive value of 98.0 per cent. There were 16 (4.8%) instances of interpretation discrepancy between the surgical resident and attending radiologist. Most differences occurred in the evaluation of abdominal CT. In no instance was management or outcome for these patients affected. This data demonstrates a low error rate in resident interpretation of after-hour CT scans of the head and abdomen in trauma, but there remains a need for the continued review of the quality of surgical resident radiologic interpretation in situations when an attending radiologist is not immediately available.

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Relevance of early head CT scans following neurosurgical procedures: an analysis of 892 intracranial procedures at Rush University Medical Center

Journal of Neurosurgery ◽

10.3171/2014.4.jns132429 ◽

2014 ◽

Vol 121 (2) ◽

pp. 307-312 ◽

Cited By ~ 12

Author(s):

Ricardo B. V. Fontes ◽

Adam P. Smith ◽

Lorenzo F. Muñoz ◽

Richard W. Byrne ◽

Vincent C. Traynelis

Keyword(s):

Operating Room ◽

Neurological Examination ◽

Medical Center ◽

Ct Scanning ◽

Ct Scans ◽

Type I ◽

Type Ii ◽

Head Ct ◽

Ct Findings ◽

Neurological Change

Object Early postoperative head CT scanning is routinely performed following intracranial procedures for detection of complications, but its real value remains uncertain: so-called abnormal results are frequently found, but active, emergency intervention based on these findings may be rare. The authors' objective was to analyze whether early postoperative CT scans led to emergency surgical interventions and if the results of neurological examination predicted this occurrence. Methods The authors retrospectively analyzed 892 intracranial procedures followed by an early postoperative CT scan performed over a 1-year period at Rush University Medical Center and classified these cases according to postoperative neurological status: baseline, predicted neurological change, unexpected neurological change, and sedated or comatose. The interpretation of CT results was reviewed and unexpected CT findings were classified based on immediate action taken: Type I, additional observation and CT; Type II, active nonsurgical intervention; and Type III, surgical intervention. Results were compared between neurological examination groups with the Fisher exact test. Results Patients with unexpected neurological changes or in the sedated or comatose group had significantly more unexpected findings on the postoperative CT (p < 0.001; OR 19.2 and 2.3, respectively) and Type II/III interventions (p < 0.001) than patients at baseline. Patients at baseline or with expected neurological changes still had a rate of Type II/III changes in the 2.2%–2.4% range; however, no patient required an immediate return to the operating room. Conclusions Over a 1-year period in an academic neurosurgery service, no patient who was neurologically intact or who had a predicted neurological change required an immediate return to the operating room based on early postoperative CT findings. Obtaining early CT scans should not be a priority in these patients and may even be cancelled in favor of MRI studies, if the latter have already been planned and can be performed safely and in a timely manner. Early postoperative CT scanning does not assure an uneventful course, nor should it replace accurate and frequent neurological checks, because operative interventions were always decided in conjunction with the neurological examination.

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Automatic assessment of the quality of patient positioning and field of view of head CT scans

Medical Imaging 2019: Imaging Informatics for Healthcare, Research, and Applications ◽

10.1117/12.2509823 ◽

2019 ◽

Author(s):

Thomas Buelow ◽

Stewart Young ◽

Tim Harder ◽

Isabelle Frischmuth ◽

Jan-Hendrik Buhk

Keyword(s):

Patient Positioning ◽

Field Of View ◽

Ct Scans ◽

Automatic Assessment ◽

Head Ct

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Radiation doses and image quality of abdominal CT scans at different patient sizes using spectral detector CT scanner: a phantom and clinical study

Abdominal Radiology ◽

10.1007/s00261-019-02247-1 ◽

2019 ◽

Vol 45 (10) ◽

pp. 3361-3368 ◽

Cited By ~ 3

Author(s):

Xinhui Duan ◽

Lakshmi Ananthakrishnan ◽

Jeffrey B. Guild ◽

Yin Xi ◽

Prabhakar Rajiah

Keyword(s):

Clinical Study ◽

Image Quality ◽

Ct Scans ◽

Radiation Doses ◽

Ct Scanner ◽

Abdominal Ct ◽

Spectral Detector Ct

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Quality of pediatric abdominal CT scans performed at a dedicated children’s hospital and its referring institutions: a multifactorial evaluation

Pediatric Radiology ◽

10.1007/s00247-016-3768-7 ◽

2017 ◽

Vol 47 (4) ◽

pp. 391-397 ◽

Cited By ~ 10

Author(s):

Aisling Snow ◽

Carly E. Milliren ◽

Dionne A. Graham ◽

Michael J. Callahan ◽

Robert D. MacDougall ◽

...

Keyword(s):

Ct Scans ◽

Abdominal Ct ◽

Children's Hospital ◽

Children’S Hospital

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The Frequency and Significance of Thoracic Injuries Detected on Abdominal CT Scans of Multiple Trauma Patients

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-198904000-00015 ◽

1989 ◽

Vol 29 (4) ◽

pp. 502-505 ◽

Cited By ~ 61

Author(s):

JAMES T. RHEA ◽

ROBERT A. NOVELLINE ◽

JAMES LAWRASON ◽

RICHARD SACKNOFF ◽

ALLEN OSER

Keyword(s):

Multiple Trauma ◽

Ct Scans ◽

Trauma Patients ◽

Thoracic Injuries ◽

Abdominal Ct ◽

Multiple Trauma Patients

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Focused Assessment with Sonography in Trauma and Abdominal Computed Tomography Utilization in Adult Trauma Patients: Trends over the Last Decade

Emergency Medicine International ◽

10.1155/2013/678380 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 19

Author(s):

Alexander Y. Sheng ◽

Peregrine Dalziel ◽

Andrew S. Liteplo ◽

Peter Fagenholz ◽

Vicki E. Noble

Keyword(s):

Computed Tomography ◽

Trauma Center ◽

Trauma Registry ◽

Imaging Modality ◽

Point Of Care ◽

Trauma Patients ◽

Abdominal Ct ◽

Head Ct ◽

Ct Utilization ◽

Over Time

Objective. We sought to describe the trend in abdominal CT use in adult trauma patients after a point-of-care emergency ultrasound program was introduced. We hypothesized that abdominal CT use would decrease as FAST use increased.Methods. We performed a retrospective study of 19940 consecutive trauma patients over the age of 18 admitted to our level one trauma center from 2002 through 2011. Data was collected retrospectively and recorded in a trauma registry. We plotted the rate of FAST and abdominal CT utilization over time. Head CT was used as a surrogate for overall CT utilization rates during the study period.Results. Use of FAST increased by an average of 2.3% (95% CI 2.1 to 2.5,P<0.01) while abdominal CT use decreased by the same rate annually. The percentage of patients who received FAST as the sole imaging modality for the abdomen rose from 2.0% to 21.9% while those who only received an abdominal CT dropped from 21.7% to 2.3%.Conclusions. Abdominal CT use in our cohort declined while FAST utilization grew in the last decade. The rising use of FAST may have played a role in the reduction of abdominal CT performed as decline in CT utilization appears contrary to overall trends.

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Less Is More? The Impact of Trauma Volume on the Positive Rate of Head Computed Tomography Scans in Head Trauma Patients

The Scientific World JOURNAL ◽

10.1100/2012/340317 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6

Author(s):

Chao-Wen Chen ◽

Yun-Ting Lou ◽

Chi-Ming Chu ◽

Hsing-Lin Lin ◽

Wei-Che Lee ◽

...

Keyword(s):

Head Trauma ◽

Tertiary Care ◽

Ct Scans ◽

Trauma Patients ◽

Care Hospital ◽

Head Ct ◽

Computed Tomography Scans ◽

Positive Rate ◽

The Impact ◽

Head Computed Tomography

Objective. Few studies have assessed the impact of trauma volume on the operational efficiency of emergency departments. Herein, we evaluate the association between trauma volume with the positive rate of head computed tomography scans in head trauma patients in a tertiary care hospital.Methods. This is a retrospective cohort review involving all head trauma patients presenting to a tertiary care hospital. Trauma census, head trauma patient volume, the number of emergent head CT scans, and the number of positive head CT scans were collected on a monthly basis. Comparison was primarily made between the trauma patient volume and the positive rate of head CT scans.Results. 25,549 trauma patients were reviewed. Of these, 5,168 (20.2%) sustained head trauma and 3,336 head CT scans were performed with mean 29.1% positive rate of substantial head injuries. The monthly data were analyzed and a statistically significant correlation between monthly trauma volume and decrease in positive rate of head CT scan was identified (Pearsonr=−0.51,P=0.02). With introducing different cut-point values of trauma volume, we identified the threshold of trauma census as approximately 4.9 and 8.8% higher than mean monthly trauma volume in discriminating significant decrease of positive rate of head CT scans.

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Risk of ionizing radiation exposure from CT scans in the Neuro ICU - a patient safety blind spot?

F1000Research ◽

10.12688/f1000research.9680.1 ◽

2016 ◽

Vol 5 ◽

pp. 2489

Author(s):

Avinash B. Kumar ◽

Roy C. Neeley

Keyword(s):

Mechanical Ventilation ◽

Patient Safety ◽

Ionizing Radiation ◽

Radiation Exposure ◽

Medical Center ◽

Academic Medical Center ◽

Ct Scans ◽

Academic Medical ◽

The Mean ◽

Ct Studies

Introduction: The exposure to ionizing radiation has increased significantly with the wide availability of computed tomography (CT) scans and portable imaging technology. We examine the pattern of use of inpatient diagnostic imaging and radiation exposure in the neuro-intensive care unit (Neuro ICU, N-ICU) patient population at a large academic medical center. Methods: We retrospectively evaluated all patients admitted to the Neuro ICU at our academic medical center from January 1 to December 31, 2013. The number and type of CT studies was collected, and the corresponding estimated radiation dose was calculated. We limited the evaluation to CT scans, which accounts for the majority of radiation exposure. Data were electronically collected and cross-referenced to the patients’ electronic medical records (EMR) and radiology records. Radiation dose estimates were calculated based on published reference values and conversion factors (CT head (2mSv)), CT angiography of the head and neck (7-10 mSv), Ct Chest /Abd/pelvis ( 10 mSv), CT cerebral perfusion analysis (3.3 mSv). Results: In the calendar year 2013, we had a total of 2353 admission encounters (F=1078). The mean age on admission was 56.55Y ± 16.7. The mean length of ICU stay was 6.3 days. Mechanical ventilation was initiated on 420 patients with a mean length on mechanical ventilation 5.09 days. 2028 CT scans were completed of which approximately 60% were head CT without contrast (n=1209). 379 patients had multiple CT studies. The mean number of studies was 3.8 ± 2. The number of patients with more thanthree3 studies during their ICU stay was 159. The maximum number of studies on a single patient was 21. Conclusion: Patients in the Neuro ICU are at a risk for significant exposure to ionizing radiation. Radiation exposure must be factored into the culture of quality and patient safety in the ICU.

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Evaluation of Concomitant Orbital Floor Fractures in Patients with Head Trauma Using Conventional Head CT Scan: A Retrospective Study at a Level II Trauma Center

Journal of Clinical Medicine ◽

10.3390/jcm8111852 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1852 ◽

Cited By ~ 1

Author(s):

Li-Kuo Huang ◽

Hsi-Feng Tu ◽

Liang-De Jiang ◽

Ying-Yuan Chen ◽

Chih-Yuan Fu

Keyword(s):

Head Trauma ◽

Predictive Value ◽

Orbital Floor ◽

Trauma Patients ◽

Head Ct ◽

High Attenuation ◽

Ct Findings ◽

Level Ii ◽

Orbital Floor Fractures ◽

High Negative Predictive Value

Background: Patients with head trauma may have concomitant orbital floor fractures (OFFs). The objective of our study was to determine the specific CT findings and investigate the diagnostic performance of head CT in detecting OFFs. Methods: We analyzed 3534 head trauma patients undergoing simultaneous head and facial CT over a 3-year period. The clinical data and specific head CT findings between patients with and without OFFs were compared. Results: In our cohort, 198 patients (5.6%) had OFFs visible on CT. On head CT, orbital floor discontinuity, gas bubbles entrapped between floor fragments, inferior extraconal emphysema, and maxillary hemosinus (MHS) were more commonly observed among patients with OFFs (p < 0.001). The absence of MHS had a high negative predictive value (99.7%) for excluding OFFs. Among the different types of MHS, the pattern showing high-attenuation opacity mixed with mottled gas had the highest positive predictive value (69.5%) for OFFs and was the only independent predictor of OFFs after adjusting for the other CT variables in all patients with MHS. Conclusion: Head CT may serve as a first-line screening tool to detect OFFs in head trauma patients. Hence, unnecessary facial CT and additional radiation exposure may be reduced.

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