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Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients

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Abstract

Background

Pediatric head trauma, including abusive head trauma, is a significant cause of morbidity and mortality.

Objective

The purpose of this research was to identify and evaluate radiologic interpretation errors of head CTs performed on abusive and non-abusive pediatric head trauma patients from a community setting referred for a secondary interpretation at a tertiary pediatric hospital.

Materials and methods

A retrospective search identified 184 patients <5 years of age with head CT for known or potential head trauma who had a primary interpretation performed at a referring community hospital by a board-certified radiologist. Two board-certified fellowship-trained neuroradiologists at an academic pediatric hospital independently interpreted the head CTs, compared their interpretations to determine inter-reader discrepancy rates, and resolved discrepancies to establish a consensus second interpretation. The primary interpretation was compared to the consensus second interpretation using the RADPEER™ scoring system to determine the primary interpretation-second interpretation overall and major discrepancy rates. MRI and/or surgical findings were used to validate the primary interpretation or second interpretation when possible. The diagnosis of abusive head trauma was made using clinical and imaging data by a child abuse specialist to separate patients into abusive head trauma and non-abusive head trauma groups. Discrepancy rates were compared for both groups. Lastly, primary interpretations and second interpretations were evaluated for discussion of imaging findings concerning for abusive head trauma.

Results

There were statistically significant differences between primary interpretation-second interpretation versus inter-reader overall and major discrepancy rates (28% vs. 6%, P=0.0001; 16% vs. 1%, P=0.0001). There were significant differences in the primary interpretation-second interpretation overall and major discrepancy rates for abusive head trauma patients compared to non-abusive head trauma patients (41% vs 23%, P=0.02; 26% vs. 12%, P=0.03). The most common findings resulting in major radiologic interpretation errors were fractures and subdural hemorrhage. Differences in the age of the patient and the percentage of patients with hemorrhage were statistically significant between the abusive head trauma versus non-abusive head trauma groups, while no statistical difference was identified for skull fractures, ischemia, head CT radiation dose, or presence of multiplanar or 3-D reformatted images. The second interpretation more frequently indicated potential for abusive head trauma compared to the primary interpretation (P=0.0001). MRI and/or surgical findings were in agreement with the second interpretation in 29/29 (100%) of patients with discrepancies.

Conclusion

A high incidence of radiologic interpretation errors may occur in pediatric trauma patients at risk for abusive head trauma who are referred from a community hospital. This suggests value for second interpretations of head CTs at a tertiary pediatric hospital for this patient population.

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 714 N. Senate Ave., Indianapolis, IN, 46202, USA

    Stephen F. Kralik, Whitney Finke, Isaac C. Wu & Chang Y. Ho

  2. Department of Pediatrics, Section of Child Protection Programs, Indiana University School of Medicine, Indianapolis, IN, USA

    Roberta A. Hibbard & Ralph A. Hicks

Authors
  1. Stephen F. Kralik
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  2. Whitney Finke
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  3. Isaac C. Wu
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  4. Roberta A. Hibbard
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  5. Ralph A. Hicks
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  6. Chang Y. Ho
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Corresponding author

Correspondence to Stephen F. Kralik.

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Conflicts of interest

Dr. R. A. Hibbard and Dr. R. A. Hicks testify in child abuse cases. Drs. Kralik, Finke, Wu and Ho report no conflicts of interest.

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Kralik, S.F., Finke, W., Wu, I.C. et al. Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients. Pediatr Radiol 47, 942–951 (2017). https://doi.org/10.1007/s00247-017-3872-3

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  • DOI: https://doi.org/10.1007/s00247-017-3872-3

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