Stacey Ann Trotter MD, PhD, Presenter: Nothing to Disclose

Paul G. Nagy PhD, Abstract Co-Author: Nothing to Disclose

David M. Yousem MD, Abstract Co-Author: Author, CMEInfo Author, Reed Elsevier

To review compliance on reporting of institutionally derived neuroradiology critical findings in an academic medical center.

We performed a radiology information system search of neuroradiology reports in one month labeled as containing a “critical finding” by a standard macro. They were analyzed for content and classified by the list of critical finding criteria established by the Departments of Neurology, Neurosurgery, Otorhinolaryngology, and Radiology. If the reported critical finding did not conform to the list, the most life-threatening finding was noted and a compilation of these findings was generated and analyzed for similarities.

461 critical findings of 5490 reports were identified. Of these, 68.8% could be classified to the critical findings list. Most fell under “New hemorrhage” (21.9%), followed by “new stroke” (13.7%), “new herniation” (8.7%), “new mass/markedly enlarging mass”, “increased intracranial pressure/cerebral edema” and “new or worsening hydrocephalus” (3.7-5.4%). Few additional reports were classified into other, much less commonly seen critical findings. 31.2% of the critical reports did not conform to the critical findings list. The findings were nonetheless regarded as meriting immediate reporting to the ordering physician. Some examples of these findings included fracture, airway compromise, orbital injury, cord inflammation/edema without infarct, and findings outside the CNS (such as lung mass or pneumothorax).

It is important that clinicians and neuroradiologists agree to a standard set of critical findings to provide guidance for communicating such important results to the ordering physicians. In an effort to provide optimal patient care, a balance needs to be achieved in deriving a list that includes the vast majority of critical findings that warrant immediate notification and a list that is so expansive the radiologists are overwhelmed with all the options possible. Reviewing the emergent findings intermittently to optimize the list is regarded as a valuable exercise.

Succinct but comprehensive definition of critical findings is essential to guiding the neuroradiologist in determining those reports meriting immediate verbal correspondence.

Trotter, S, Nagy, P, Yousem, D, Assigning and Reporting of Critical Findings in Neuroradiology.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11016940.html