Second thoughts: Emergency clinicians see value in secondary interpretations

Secondary interpretations of imaging studies performed at another facility are increasingly common in radiology, particularly emergency radiology. While data suggests there are often discrepancies found between original and secondary reports, the benefit from the clinician perspective is unclear.

An anonymous electronic survey on secondary interpretations was circulated to 58 attending adult emergency physicians and trauma surgeons at a Level I trauma center from March 2018 to April 2018. Chi-squared testing was used for statistical analysis.

80.8% of respondents requested secondary interpretations either "always" or "most of the time." Over half of the respondents cited trust in the house radiologist interpretation as the primary reason for secondary interpretation requests. 92.3% and 84.6% of respondents felt that the ability to obtain second interpretations improves patient care and facilitates disposition, respectively. 88.5% of respondents reported reduced imaging utilization due to secondary reads. When presented with conflicting interpretations, all trauma surgeons would rely on the in-house interpretation, whereas 50% of the emergency physicians would pursue further imaging (p < 0.05). 96.2% of respondents were uncertain about insurance coverage of secondary interpretations, but 73.1% would continue to order them, regardless.

Secondary reads were heavily utilized, felt to influence patient care, reduced additional imaging and aided in disposition, suggesting clinical benefit. When presented with conflicting reports, trauma surgeons would rely on the in-house interpretation whereas emergency physicians more often opted to pursue additional imaging. Most respondents would still request secondary interpretations despite being unaware of insurance coverage for these interpretations.