Analysis of critical report notification from musculoskeletal radiology in a tertiary academic medical institution with a regional trauma center

• Published in: PloS one 2022-01, Vol.17 (1), p.e0262511-e0262511
• Main Authors: Ahn, Tae Ran, Jeong, Yu Mi, Park, So Hyun, Jeon, Ji Young, Lee, Sheen-Woo, Shim, Young Sup
• Format: Article
• Language: English
• Subjects: Analysis; Body parts; Communication; Diagnostic Imaging - statistics & numerical data; Diagnostic Imaging - trends; Electronic Health Records; Electronic medical records; Emergency medical care; Emergency medical services; Evaluation; Evaluation Studies as Topic; Extremities; Fractures; Fractures, Bone - diagnostic imaging; Health care facilities; Humans; Infections; Lesions; Magnetic resonance imaging; Malignancy; Medical imaging equipment; Medical records; Medical schools; Medicine; Medicine and Health Sciences; Musculoskeletal system; Musculoskeletal System - diagnostic imaging; Patients; People and Places; Physicians; Program Evaluation; Radiography - methods; Radiology; Radiology - methods; Radiology Department, Hospital - trends; Republic of Korea; Research and Analysis Methods; Retrospective Studies; Spine; Tertiary; Tertiary Healthcare; Trauma; Trauma Centers; Ultrasonic imaging
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0262511

We aimed to analyze the prevalence, causes, and clinical settings of 4-year critical radiologic reports (CRRs) notified from the musculoskeletal section of the radiology department. Then, we investigated the communication outcomes. This study was approved by our institutional review board. We retrospectively included 175 musculoskeletal CRRs from our database between January 2017 and December 2020. The CRRs were analyzed by two musculoskeletal radiologists, who categorized the CRRs by clinical setting (emergency department(ED) patient, outpatient, and inpatient), body part, type of image modality, reason for CRR, incidental lesion, and clinical outcome. The clinical outcome was retrieved from the electronic medical records. The 175 musculoskeletal CRRs accounted for 5.4% of the CRRs (n = 3217) available in the study period. Most CRRs (94.9%, 166/175) corresponded to the musculoskeletal system, while the remaining ones (5.1%, 9/175) corresponded to the non-musculoskeletal system. In addition, the spine, extremities, and thoracic cage accounted for 52.6%, 40.6%, and 1.7% of the musculoskeletal CRRs, respectively. Moreover, most patients presented to the ED (50.3%, 88/175), followed by inpatients (30.9%, 54/175), and outpatients (18.9%, 33/175). The CRR reasons included missed fracture (54.3%), suspected malignancy (16%), clinical emergency (10.3%), unexpected infection/inflammation (11.4%), and others (8%). Furthermore, 11 (6.3%) incidental lesions were not related to the primary imaging purpose. Referring clinicians actively acknowledged 80% of the CRRs. The loss to follow-up action was the highest in the ED patients (35.2%, 31/88; p < 0.001), being significantly higher than that in outpatients (6.1%, 2/33) and inpatients (3.7%, 2/54). Missed fractures were the most common cause of musculoskeletal CRRs. ED showed prevalence in musculoskeletal CRRs and reflected the highest loss to follow-up action. ED physicians should pay more attention to CRRs to enhance patient care.