Purpose or Case Report: Effective triage and timely communication are critical for optimal patient care. MSK diagnoses that are considered emergent (requiring immediate attention), urgent (warranting attention sooner), and non-urgent (necessitating follow-up) are not yet defined. The purposes of this project are 1) to define the clinical importance of MSK diagnoses and the preferred communication methods, and 2) to investigate differences between subspecialties and between those with different years in practice.
Methods & Materials: This IRB-exempt, anonymized and web-based RedCap survey was generated by an expert-panel of 3 radiologists and 4 orthopedic surgeons at our institution, a tertiary children’s hospital, and disseminated to all physicians within the departments of Radiology and Orthopedics. Participants provided their subspecialties (radiologist, orthopedic-specialized pediatrician, orthopedic surgeon), years in practice (fellow, <5 years, 5-10 years, and >10 years), all diagnoses they would consider emergent, urgent, and non-urgent and their preferred communication method. The data was analyzed using descriptive analyses and bivariate analyses including Chi-square and Fisher’s exact tests.
Results: Thirty-nine surveys (49%) were received, 26 from radiologists, 4 pediatricians, and 9 surgeons, to yield a total of 265 diagnostic entries (111 emergent, 98 urgent, and 56 non-urgent). Fractures with potential for instability was the most frequently listed emergent (19%) and urgent diagnosis (16%), while non-aggressive lesion was the most frequently listed non-urgent diagnosis (23%). Communication by phone was preferred for emergent and urgent diagnoses and by email for non-urgent diagnoses. There was no significant difference in the distribution of diagnoses between subspecialties (p=0.257) or levels of experience (p=0.373). While radiologists listed post-instrumentation findings (not otherwise specified, malalignment, non-perfusion) and avascular necrosis as diagnoses that require communication, these were not listed by the orthopedics. No diagnoses listed by the orthopedics were not also listed by the radiologists.
Conclusions: Among physicians of different subspecialties and years of experience, there is an overall consensus on the clinical importance of various MSK diagnoses, which is particularly critical for radiologists as our field adapts to increasing patient/family access to electronic medical records and legislative requirements to
communicate significant abnormalities directly with our patients.