Purpose or Case Report: In an effort to improve communication of important radiology findings, we designed and deployed a unique comprehensive radiology report categorization (RADCAT) system that organizes results by acuity and need for radiology follow-up. The goal of our study is to outline and compare the distribution of RADCAT pediatric imaging reports from three different clinical settings.
Methods & Materials: Our 87-bed pediatric teaching hospital is part of a multihospital academic tertiary care referral center. The RADCAT system was designed to categorize results of all diagnostic imaging studies at our health center and includes 5 categories: RADCAT1 – “Normal result”, RADCAT2 – “Routine result”, RADCAT3 – “Result with recommendation for non-urgent follow-up”, RADCAT4 – “Priority result”, and RADCAT5 – “Critical result”. The grading system was implemented at our pediatric hospital in October 2017, after which every report generated within our dictation system required a RADCAT grade as a discrete data element prior to being finalized by the radiologist. Using standard search functions, we reviewed 2 years of data (October 1, 2017 – September 30, 2019) from the electronic health record to evaluate the distributions of report grading for pediatric patients in the emergency department (ED), inpatient, and outpatient settings.

Results: During the 2-year period review, 109,706 total RADCAT grades were assigned to pediatric imaging studies (21.3% RADCAT1, 48.7% RADCAT2, 3.9% RADCAT3, 25.7% RADCAT4, and 0.4% RADCAT5). There were several observations made when comparing the distributions of RADCAT categories from the ED, inpatient, and outpatient settings. Overall, ED and outpatient imaging study distributions were similar. Pediatric ED and outpatient imaging studies were six-times more likely to be graded with RADCAT1 and two-times more likely to be graded with RADCAT2 than inpatient imaging studies. Pediatric inpatient imaging studies had a higher proportion of RADCAT4 and RADCAT 5 results than ED or outpatient studies.
Conclusions: The RADCAT system has been successfully deployed throughout our pediatric hospital and provides a means for large-scale data analytics for continuous practice quality improvement and research. Based on review of 2 years of RADCAT distribution data, ED and outpatient imaging study distributions are similar with greater proportions of lower acuity studies in comparison to that of inpatient imaging studies.