Neuroimaging disagreements and consequences among pediatric transfers with concern for abuse.
Community/adult radiologists and pediatric neuroradiologists disagreed on 33% of abuse-concern neuroimaging pairs
Neuroimaging disagreements and consequences among pediatric transfers with concern for abuse.
Previous research supports substantial differences between pediatric neuroimaging interpretations by non-pediatric and pediatric-trained radiologists, however little is known about how this applies within the context of child abuse.
Compare interpretations of head computed tomography and magnetic resonance imaging studies between community/adult academic radiologists and academic pediatric neuroradiologists.
This retrospective secondary analysis of data extracted from radiology and electronic health records used descriptive statistics to examine sample characteristics, imaging interpretation analysis (agreement, minor/major disagreement), and consequences of disagreements.
adult and pediatric radiologists reached different read-outs on a third of abuse-concern scans
The analytic sample consisted of 100 cases of children less than 1 year old (76%) who underwent neuroimaging studies including computed tomography (n = 98) and magnetic resonance imaging scans (n = 2).
Common major disagreements involved missed skull fractures (38.3%) and missed intracranial hemorrhages (30%), whereas common minor disagreements involved missed scalp swelling (38%) and incorrect skull fracture diagnosis (26%).
Sixty-eight instances of disagreement altered clinical diagnosis and/or management related to child abuse evaluations.
Given the critical clinical and investigative implications surrounding concern for child abuse, access to experienced pediatric-trained neuroradiologists is essential in minimizing interpretation errors and reducing consequences for patients, providers, and health care organizations.