Interpretation of emergency CT scans in polytrauma: trauma surgeon vs radiologist

Time is critical in the trauma setting. Emergency computed tomography (CT) scans are usually interpreted by the attending doctor and plans to manage the patient are implemented before the formal radiological report is available. This study aims to investigate the discrepancy in interpretation of emergency whole body CT scans in trauma patients by the trauma surgeon and radiologist and to determine if the difference in trauma surgeon and radiologist interpretation of emergency trauma CT scans has an impact on patient management.

This prospective observational comparative study was conducted over a 6 month period (01 April-30 September 2016) at the Inkosi Albert Luthuli Central Hospital which has a level 1 trauma department. The study population comprised 62 polytrauma patients who underwent a multiphase whole body CT scans as per the trauma imaging protocol. The trauma surgeons' initial interpretation of the CT scan and radiological report were compared. All CT scans reported by the radiology registrar were reviewed by a consultant radiologist. The time from completion of the CT scan and completion of the radiological report was analysed.

Since the trauma surgeon accompanied the patient to radiology and reviewed the images as soon as the scan was complete, the initial interpretation of the CT was performed within 15-30 min. The median time between the CT scan completion and reporting turnaround time was 75 (16-218) min. Critical findings were missed by the trauma surgeon in 4.8% of patients (bronchial transection, abdominal aortic intimal tear and cervical spine fracture) and non-critical/incidental findings in 41.94%. The trauma surgeon correctly detected and graded visceral injury in all cases.

There was no significant discrepancy in the critical findings on interpretation of whole body CT scans in polytrauma patients by the trauma surgeon and radiologist and therefore no negative impact on patient management from missed injury or misdiagnosis.The turnaround time for the radiology report does not allow for timeous management of the trauma patient.