Discordance in CT interpretations between pediatric radiology overreads and community and adult radiologists reads following traumatic injury.

INTRODUCTION

For pediatric trauma patients, imaging interpretations from transferring institutions may differ from those of pediatric radiologists. At our Level I pediatric trauma center, all outside CT scans are reinterpreted by pediatric radiologists. This study evaluates the discordance rate between initial outside CT interpretations and pediatric overreads, examining whether continued secondary review is needed.

METHODS

We retrospectively compared CT interpretations of pediatric radiologists and transferring radiologists in pediatric trauma patients transferred to our center from 2021 to 2023. Included patients had a documented injury, an outside interpretation, and a pediatric overread. CT scans reviewed included the head, cervical/thoracic/lumbar spine, chest, and abdomen & pelvis (A&P).

RESULTS

A total of 500 patients with 1,192 CT scans were included. Overall discordance was 16 % (189/1,192). Patients with discordant scans had higher injury severity scores (ISS 14 vs. 10, p = 0.006). CT A&P had the highest discordance rate at 25 % (101 scans, p < 0.001), and the second highest rate of major treatment changes (38 %, p < 0.001). CT C-spine had the highest rate of discordant scans resulting in major treatment change (63 %, p < 0.001). Only 13 discordant cases would have changed transfer decisions; eleven involved CT head scans.

CONCLUSION

Significant discordance exists between outside and pediatric radiologist CT interpretations in pediatric trauma, particularly for CT A&P. Although head CT overreads were the only scans that might have prevented transfer, the overall discordance rate justifies the need for pediatric radiologist review at Level I pediatric trauma centers.