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Organ laceration grading adherence by radiologists.
Vivek Bihari Kalra1, Xiao Wu, Jamal Bokhari
1Department of Diagnostic Radiology, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT, 06520-8042, USA, vivekkalramd@gmail.com.
Emergency Radiology
|October 11, 2014
Summary
A departmental intervention significantly increased radiologist adherence to the American Association for the Surgery of Trauma (AAST) grading system for abdominopelvic organ lacerations. However, compliance decreased over time, indicating a need for ongoing reinforcement.
Area of Science:
- Radiology and Imaging
- Trauma Surgery
- Medical Informatics
Background:
- The American Association for the Surgery of Trauma (AAST) grading system is crucial for managing abdominopelvic organ lacerations non-operatively.
- Radiologist adherence to AAST grading criteria impacts patient management decisions.
- A single departmental intervention was implemented to improve AAST grading adherence.
Purpose of the Study:
- To evaluate the impact of a one-time departmental intervention on the use of the AAST abdominopelvic organ laceration grading system by radiologists.
- To assess the change in AAST grading adherence before and after the intervention.
- To determine if grading could be inferred from non-graded reports.
Main Methods:
- A retrospective review of traumatic abdominopelvic CT reports was conducted over a 2-year period, before and after a departmental intervention.
- Reports were analyzed for the presence of organ lacerations and whether they were graded using AAST criteria.
- Statistical analysis (t-test) was used to compare grading rates pre- and post-intervention.
Main Results:
- The rate of AAST grading for abdominopelvic organ lacerations significantly increased from 38% (31/81) pre-intervention to 75% (59/79) post-intervention (p < 0.0001).
- A decreasing trend in grading adherence was observed over time following the intervention.
- While some non-graded reports allowed inference of AAST grading, key details like parenchymal depth were often omitted.
Conclusions:
- A one-time departmental intervention effectively improved adherence to AAST laceration grading among radiologists.
- The observed decline in compliance over time highlights the need for sustained reinforcement strategies.
- Current AAST grading may benefit from incorporating elements like active extravasation, which is routinely reported.
