Robert Peter Klein1, Gary Velan1, Noel Young1,2, Amith Shetty3, Michelle Moscova4. 1. Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, 2052, Australia. 2. Department of Radiology, Westmead Hospital, Darcy Rd, Westmead, NSW, 2145, Australia. 3. Department of Emergency Medicine, Westmead Hospital, Darcy Rd, Westmead, NSW, 2145, Australia. 4. Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, 2052, Australia. m.moscova@unsw.edu.au.
Abstract
PURPOSE: The current study aimed to evaluate the appropriateness of the decisions made to order diagnostic imaging for emergency trauma patients. METHODS: A retrospective audit of 642 clinical decisions for 370 non-consecutive trauma cases was conducted at a level 1 adult trauma centre. Radiographs and computed tomography investigations were compared for compliance with the American College of Radiology/European Society of Radiology (ACR/ESR) imaging guidelines. The non-compliant imaging orders were evaluated for the following medical officer ranks: Junior Medical Officer (JMO), Senior Resident Medical Officer (SRMO), Emergency Medicine Registrar (EMR) and Consultants/Career Medical Officer (CMO). The time of imaging order (day/evening or night shift), whether the imaging led to conservative or surgical patient management, and whether the imaging order decisions led to a change in the clinical management of the patient were also considered. RESULTS: Non-compliance with the ACR/ESR guidelines was low. At least half of non-compliant decisions made by each level of medical officer resulted in a change in patient management. In total, 11 (65%), 25 (53%), 12 (63%) and 11 (52%) of non-compliant imaging orders placed by JMOs, SRMOs, EMRs and Consultants, respectively, resulted in change of patient management. JMOs and SRMOs ordered a significantly higher proportion of non-compliant imaging studies for conservatively managed patients in comparison to surgically managed patients. CONCLUSION: This study highlighted that most non-compliant imaging orders benefited the patient.
PURPOSE: The current study aimed to evaluate the appropriateness of the decisions made to order diagnostic imaging for emergency traumapatients. METHODS: A retrospective audit of 642 clinical decisions for 370 non-consecutive trauma cases was conducted at a level 1 adult trauma centre. Radiographs and computed tomography investigations were compared for compliance with the American College of Radiology/European Society of Radiology (ACR/ESR) imaging guidelines. The non-compliant imaging orders were evaluated for the following medical officer ranks: Junior Medical Officer (JMO), Senior Resident Medical Officer (SRMO), Emergency Medicine Registrar (EMR) and Consultants/Career Medical Officer (CMO). The time of imaging order (day/evening or night shift), whether the imaging led to conservative or surgical patient management, and whether the imaging order decisions led to a change in the clinical management of the patient were also considered. RESULTS: Non-compliance with the ACR/ESR guidelines was low. At least half of non-compliant decisions made by each level of medical officer resulted in a change in patient management. In total, 11 (65%), 25 (53%), 12 (63%) and 11 (52%) of non-compliant imaging orders placed by JMOs, SRMOs, EMRs and Consultants, respectively, resulted in change of patient management. JMOs and SRMOs ordered a significantly higher proportion of non-compliant imaging studies for conservatively managed patients in comparison to surgically managed patients. CONCLUSION: This study highlighted that most non-compliant imaging orders benefited the patient.
Authors: Hemal K Kanzaria; Jerome R Hoffman; Marc A Probst; John P Caloyeras; Sandra H Berry; Robert H Brook Journal: Acad Emerg Med Date: 2015-03-23 Impact factor: 3.451
Authors: David Drynan; Milford McArthur; Ashray Vohora; Darren Hinton; Grant Menegon; Matthew P R Wilkinson Journal: ANZ J Surg Date: 2018-03-01 Impact factor: 1.872
Authors: Pari V Pandharipande; Andrew T Reisner; William D Binder; Atif Zaheer; Martin L Gunn; Ken F Linnau; Chad M Miller; Laura L Avery; Maurice S Herring; Angela C Tramontano; Emily C Dowling; Hani H Abujudeh; Jonathan D Eisenberg; Elkan F Halpern; Karen Donelan; G Scott Gazelle Journal: Radiology Date: 2015-09-24 Impact factor: 11.105
Authors: Edward R Melnick; Katherine Shafer; Nayeli Rodulfo; Joyce Shi; Erik P Hess; Robert L Wears; Rija A Qureshi; Lori A Post Journal: Acad Emerg Med Date: 2015-11-14 Impact factor: 3.451