Formalized radiology rounds: the final component of the tertiary survey

BACKGROUND: An important objective of organized trauma care is to minimize delayed diagnoses and missed injuries. Discrepant interpretations of radiographs initially read by trauma surgeons represent a unique source of delayed diagnoses. The purpose of this study was to evaluate the efficacy of formalized radiology rounds as a component of the tertiary survey. METHODS: Over an 18-month period, 432 consecutive patients admitted to the trauma service at a Level II trauma center were studied prospectively. Radiographs obtained as part of the initial evaluation were initially interpreted by an attending trauma surgeon. All radiographs from the previous 24-hour admissions were reviewed by the trauma team with an attending radiologist at radiology rounds. New diagnoses (NDx) were defined as radiographic findings identified at radiology rounds that were not recorded by the trauma surgeon at the time of initial evaluation. The clinical significance of any NDx was described as follows: level 1, NDx resulted in significant morbidity/mortality; level 2, NDx resulted in alteration in care/no morbidity; level 3, NDx resulted in no alteration in care; level 4, NDx was an incidental finding by the radiologist; level 5, NDx by radiologist not definite. RESULTS: Forty-seven NDx were identified in 42 patients (9.7%). Of the 47 NDx, 19 (40.4%) were level 3 and 28 (59.6%) were level 2. No level 1 NDx were identified. Forty-four changes in clinical management were documented in the level 2 group. Eight new consults were ordered in seven patients (16.7%): orthopedic surgery (n = 6), neurosurgery (n = 1), and physical therapy (n = 1). Seventeen additional diagnostic procedures were required in 16 patients (38.1%): plain radiographs (n = 11) and computed tomographic scans (n = 6). Nineteen therapeutic changes were required in 16 patients (38.1%): splint/immobilization device (n = 7), modified level of activity (n = 6), surgical procedures (n = 4), transfer (n = 1), and home equipment (n = 1). CONCLUSION: A small number of radiographic findings are not detected by trauma surgeons during the initial evaluation. Although these findings are not of major clinical significance, the majority required some alteration in care plan. Formalized radiology rounds promotes clinical efficiency through early identification of these injuries, which facilitates any necessary alteration in the care plan.