Purpose or Case Report: Imaging during the evaluation of suspected child abuse victims may be requested 24 hours a day, however, pediatric radiologists may not always be available to interpret these studies. Timely reporting is important for treatment and disposition in this vulnerable population. In addition, the accuracy of detection of subtle injuries is critical for patient safety. The current protocol at our institution consists of an immediate preliminary interpretation by an adult radiologist when a skeletal survey is obtained after hours, and final interpretation by one of three pediatric radiologists during normal business hours.
Methods & Materials: A retrospective cohort study was performed analyzing inpatient and emergency room skeletal surveys performed at a pediatric hospital for traumatic indications in 2017 and 2018, and related imaging and clinical data in the following month.
Results: Of 155 skeletal surveys, there were 15 (9.7%) cases with discrepancies related to misinterpretation of trauma, including additional fractures in 10, fractures diagnosed when there were none in 2, non-metaphyseal fracture diagnosed as metaphyseal in 1, subacute rib fractures described as healed in 1, and spine trauma questioned when there were congenital anomalies in 1. These discrepancies were classified as a clinically significant misinterpretation in 14 (9%) of the studies. In 7 (4.5%) cases, the change in interpretation resulted in a change in the child’s disposition regarding non-accidental trauma or a change in management.
Conclusions: A protocol of an adult radiologist providing a preliminary report for skeletal surveys obtained after hours for suspected non-accidental trauma followed by a pediatric radiologist interpretation during normal business hours is an effective way to provide timely information, while also providing a safety net for the detection of additional significant injuries. The discrepancy rate at our institution is higher than that documented in the literature between pediatric radiologists, but lower than that described on skeletal surveys referred to a pediatric hospital for a second opinion. This serves as baseline data for future educational outreach to our adult radiology colleagues, for the purpose of quality improvement.