Does Officially Documenting Second Opinions of Outside CT Imaging Studies Reduce the Rate of Repeat Imaging in Pediatric ED Patients?

Abstract

Purpose: There is wide institutional policy variation and continued debate on whether radiologists ought to provide second opinions on external images. In this study, we assess the value of second opinions in reducing imaging utilization by determining whether formal second opinion interpretations of outside CTs accompanying pediatric transfer patients lead to less subsequent radiology (CT and MRI) imaging in our emergency department (ED). Methods: We performed a retrospective study of pediatric (ages 0-18) electronic medical records that contained external CTs uploaded during ED admissions between May 2011 and June 2012 at our institution. Each patient's medical record was reviewed to determine the indication and presenting complaints and if a repeat CT or additional MRI imaging was performed. Results: 671 outside pediatric CT images were uploaded into our institution’s image repository (PACS) and of these, 29% (196/671) met our inclusion criteria of being uploaded during an ED admission and within 48 hours of the patient’s transfer. Patients may have lower odds of undergoing a repeat CT if they had a second opinion read (OR 0.8475, 95% CI 0.29 – 2.52) but greater odds of undergoing an additional MRI (OR 1.5, CI 0.73 – 3.08) when there was an official read than not. However, our results did not reach statistical significance (p = 0.7658 and 0.2685 respectively). Conclusion: Although our results did not reach statistical significance, our study suggests that official documentation of second opinions of outside imaging studies may lead to less repeat CT imaging in pediatric ED patients.