Majid Chalian MD, Presenter: Nothing to Disclose

Filippo Del Grande MD, MBA, Abstract Co-Author: Nothing to Disclose

Rashmi Savyasachi Thakkar MD, Abstract Co-Author: Nothing to Disclose

Sahar Jalali Farahani MBBS, Abstract Co-Author: Nothing to Disclose

Avneesh Chhabra MD, Abstract Co-Author: Research Grant, Siemens AG Research Consultant, Siemens AG Research Grant, Integra LifeSciences Holdings Corporation Research Grant, General Electric Company

Shadpour Demehri MD, Abstract Co-Author: Nothing to Disclose

Laura Marie Fayad MD, Abstract Co-Author: Nothing to Disclose

John A. Carrino MD, MPH, Abstract Co-Author: Research Grant, Siemens AG Research Grant, Carestream Health, Inc Research Grant, Toshiba Corporation Consultant, BioClinica, Inc Consultant, Pfizer Inc Consultant, Medtronic, Inc Advisory Board, General Electric Company Advisory Board, Siemens AG Advisory Board, Carestream Health, Inc

To assess the patient care benefit of an institutional policy requiring official second-opinion consultation for all imaging examinations performed outside the institution.

The institutional review board approved the retrospective review of patient data for this HIPAA-compliant study and waived the need for individual informed consent. Two trained radiology fellows compared the second-opinion consultation reports for outside musculoskeletal radiology exams within calendar years 2010 and 2011 with the outside original reports. The reports were categorized by using a five-point ordinal rating scale: 1, no difference in interpretation; 2, clinically unimportant differencein detection; 3, clinically unimportant differencein interpretation; 4, clinically important difference in detection; and 5, clinically important difference in interpretation. Clinically important differences were defined as those likely to change patient care or diagnoses. Inter-observer reliability was assessed using linear-weighted kappa. 

Of 3165 exams, 2326 (73.5%) had an outside report for comparison. There were 472 (20.3%) instances with clinically important differences. Of these 472 discrepancies, 214 (45.3%) were category 4 and 258 (54.7%) were category 5. When definitive diagnoses was obtainable from pathology reports (580 exams), 102 (17.4%) studies had clinically important discrepancies between inside and outside reports. There was a very good agreement (kappa=0.93) between readers in scoring the discrepancies.

A 20.3% rate of discrepant interpretations (472 of 2326 studies) was noted for a service offering second-opinion consultations for outside examinations. Most were discrepancies in interpreting identified abnormalities rather than in detecting abnormalities. When a definitive diagnosis was obtainable, there was clinically important discrepancy in 17.4% of studies between the second-opinion consultation and the outside reports.

Results of this study could be helpful for health care decision makers regarding second-opinion subspecialty consultation value in musculoskeletal radiology.

Chalian, M, Del Grande, F, Thakkar, R, Farahani, S, Chhabra, A, Demehri, S, Fayad, L, Carrino, J, Second-opinion Consultations in Musculoskeletal Radiology.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13025049.html