Curiosity in Yuma Leads to Study on the Utility of Radiology Over Reads
Dr. John Glick and other primary care providers at Yuma Clinic and Hospital in Yuma, Colorado were curious how often official radiology reads for extremity joints changed plan of care in their practice. Many rural health clinics and hospitals lack onsite radiologists. The primary care provider (PCP) often interprets plain radiographs and begins treatment before receiving an official read from a radiologist. Previous studies to determine if interpretations of radiographs by PCPs agree with interpretations from radiologists have mainly been done in urban or academic centers. This study assessed the concordance for plain radiograph interpretations between PCPs in Yuma, CO and radiologists. The study also determined if there were specific joints or injury patterns where the practice should automatically request stat over reads.
Chart audit data were reviewed for patients aged 18 years and older who had received care at the Yuma hospital or clinic that included plain radiographs for extremity injury. Convenience samples of 30 cases for each of the following joints were obtained: ankle, knee, hip, write, elbow, and shoulder. Of 180 cases, 166 (92%) were cases where the PCP and radiologist interpretations agreed. The remaining 14 cases (8%) had discordant reads. Of those, the PCP had made the correct interpretation in 4. Four cases (2.2%) required a change in care. See Table 1 for a description of care changes.
PCPs’ interpretations of radiographs had a very high overall concordance with radiologists’ interpretations. Further, this rate falls in the range of concordance found in previous studies (90%-95%). No specific injury patterns or joint subsets were found that would trigger an automatic request for a stat over read. CU Medical student Nicholas Mouw, Dr. Jack Westfall, and the High Plains Research Network partnered with Dr. Glick to conduct this study. A similar study on over reads is under development with Dr. Gary Grasmick and others at the Prairie View Clinic in Cheyenne Wells.