Lukasz Babiarz MD, MBA, Presenter: Nothing to Disclose

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

We prospectively assessed our staff neuroradiologists’ adherence to our hospital-approved neuroradiology critical findings list which requires urgent communication with the primary clinical team for specific radiographic findings.

A list of critical neuroradiological findings was developed with neurology, neurosurgery, and otolaryngology departments. This list includes 17 categories: hemorrhage, stroke, mass, edema, herniation, hydrocephalus, malfunctioning hardware, infection, child abuse, vascular abnormality, cord compression, cord infarction, spinal instability, congenital variation altering surgery, acute fracture, globe/retina/optic nerve compromise, and airway compromise. Per policy, a neuroradiologist is required to communicate, document the communication, and mark the report with an electronic “flag” when a critical finding is encountered. As a part of our quality assessment process, we reviewed 50 random neuroradiology reports monthly for the presence of critical findings and appropriate action.

450 reports were reviewed between July 2011 and March 2012. 79 of 450 (17.6%) had, and 371 of 450 (82.4%) did not have, a critical finding. 68 of 79 (86.1%) cases with critical findings were properly handled, 7 of 79 (8.9%) were not communicated to the primary team (cord compression, stroke, infection, vascular abnormality, mass, acute fracture, globe injury), and 4 of 79 (5.1%) were communicated to the primary team but not flagged (herniation, hemorrhage, acute fracture). For 366 of 371 (98.7%) cases without critical findings no action was taken. 2 of 371 (0.5%) were communicated to the primary team (thyroid nodules, moderate spinal canal stenosis), and 3 of 371 (0.8%) were communicated and flagged (scalp hematoma, inflammatory cord changes, nasal bone fracture). The 5 most common critical findings were: acute fracture (15 of 79), hemorrhage (12 of 79), infection (11 of 79), stroke (11 of 79), and vascular abnormality (11 of 79).

A prospective review of compliance with a hospital-approved neuroradiology critical findings list found that 96.4% (434/450) of cases were appropriately handled. However 13.9% (11/79) of critical findings were at least partially mishandled.

Reporting of critical findings in neuroradiology must be monitored to ensure compliance and to identify areas for improvement.

Babiarz, L, Yousem, D, Prospective Assessment of Staff Neuroradiologists’ Adherence to Hospital-approved Critical Findings List.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12026780.html