TY - JOUR
T1 - Quality use of diagnostic imaging in trauma, and the impact on emergency medical practice : a retrospective clinical audit
AU - Klein, Robert Peter
AU - Velan, Gary
AU - Young, Noel
AU - Shetty, Amith
AU - Moscova, Michelle
PY - 2021
Y1 - 2021
N2 - Purpose: The current study aimed to evaluate the appropriateness of the decisions made to order diagnostic imaging for emergency trauma patients. Methods: A retrospective audit of 642 clinical decisions for 370 non-consecutive trauma cases was conducted at a level 1 adult trauma centre. Radiographs and computed tomography investigations were compared for compliance with the American College of Radiology/European Society of Radiology (ACR/ESR) imaging guidelines. The non-compliant imaging orders were evaluated for the following medical officer ranks: Junior Medical Officer (JMO), Senior Resident Medical Officer (SRMO), Emergency Medicine Registrar (EMR) and Consultants/Career Medical Officer (CMO). The time of imaging order (day/evening or night shift), whether the imaging led to conservative or surgical patient management, and whether the imaging order decisions led to a change in the clinical management of the patient were also considered. Results: Non-compliance with the ACR/ESR guidelines was low. At least half of non-compliant decisions made by each level of medical officer resulted in a change in patient management. In total, 11 (65%), 25 (53%), 12 (63%) and 11 (52%) of non-compliant imaging orders placed by JMOs, SRMOs, EMRs and Consultants, respectively, resulted in change of patient management. JMOs and SRMOs ordered a significantly higher proportion of non-compliant imaging studies for conservatively managed patients in comparison to surgically managed patients. Conclusion: This study highlighted that most non-compliant imaging orders benefited the patient.
AB - Purpose: The current study aimed to evaluate the appropriateness of the decisions made to order diagnostic imaging for emergency trauma patients. Methods: A retrospective audit of 642 clinical decisions for 370 non-consecutive trauma cases was conducted at a level 1 adult trauma centre. Radiographs and computed tomography investigations were compared for compliance with the American College of Radiology/European Society of Radiology (ACR/ESR) imaging guidelines. The non-compliant imaging orders were evaluated for the following medical officer ranks: Junior Medical Officer (JMO), Senior Resident Medical Officer (SRMO), Emergency Medicine Registrar (EMR) and Consultants/Career Medical Officer (CMO). The time of imaging order (day/evening or night shift), whether the imaging led to conservative or surgical patient management, and whether the imaging order decisions led to a change in the clinical management of the patient were also considered. Results: Non-compliance with the ACR/ESR guidelines was low. At least half of non-compliant decisions made by each level of medical officer resulted in a change in patient management. In total, 11 (65%), 25 (53%), 12 (63%) and 11 (52%) of non-compliant imaging orders placed by JMOs, SRMOs, EMRs and Consultants, respectively, resulted in change of patient management. JMOs and SRMOs ordered a significantly higher proportion of non-compliant imaging studies for conservatively managed patients in comparison to surgically managed patients. Conclusion: This study highlighted that most non-compliant imaging orders benefited the patient.
UR - https://hdl.handle.net/1959.7/uws:65227
U2 - 10.1007/s10140-021-01921-6
DO - 10.1007/s10140-021-01921-6
M3 - Article
SN - 1070-3004
VL - 28
SP - 761
EP - 770
JO - Emergency Radiology
JF - Emergency Radiology
IS - 4
ER -