Worth another look: Second opinion reads are more accurate at pediatric hospitals

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Substantial discrepancy rates exist between imaging interpretations of radiologists at outside referring intuitions and those of radiologists at tertiary care children’s hospitals, according to a study published in the October issue of the American Journal of Roentgenology.

Original and second interpretations were in agreement in the majority of cases, though disagreements were found in 41.8 percent of reports, and 21.7 percent of reports featured major disagreements between first and second interpretations, according to J. Herman Kan, MD,  of Texas Children’s Hospital in Houston, and colleagues. Second interpretations were significantly correlated with the final diagnosis.

“These results indicate that interpretations by subspecialty radiologists at a point-of-care facility provide important clinical information about the pediatric patient and should be recognized by payers as integral to optimal care,” wrote the authors.

Kan and colleagues’ findings were based on a retrospective chart review of diagnostic imaging reports for all pediatric patients referred to a tertiary care children’s hospital from Jan. 1, 2009, to May 31, 2010. Original and second interpretations were compared by a fellowship-trained pediatric radiologist and neuroradiologist. A total of 773 exams were included.

Disagreements were found in 323 of the 773 reports, according to the authors. In addition to the 21.7 percent of reports with major disagreements, 20 percent featured minor disagreements. Reinterpretations were most frequently requested for neurologic studies, with major and minor disagreements occurring in 12.6 percent and 21.3 percent of neurologic cases, respectively. The most common major disagreements dealt with the presence of fracture and hemorrhage.

Body imaging cases featured major and minor disagreements in 32.6 percent and 18.7 percent of cases, respectively, according to the authors. Indications for appendicitis were the cause of 40.3 percent of major disagreements in nontraumatic abdominal imaging cases.

Radiographic studies were reinterpreted in only 5.3 percent of cases, and major and minor disagreements occurred in 36.6 percent and 17.1 percent of reinterpretations, respectively.

In the cohort of cases where final diagnosis was known, the second interpretation was more accurate than the orginal in 90.2 percent of cases, according to Kan and colleagues.

The authors acknowledged that reinterpretation of outsides studies is costly and adds to tertiary facility workloads, but wrote disagreements between interpretations “carry substantial implications for subsequent management and substantial implications for allocation of medical resources.“