Cost analysis of violence-related medical imaging in a Free State tertiary trauma unit

Background: Violence is a leading public health problem worldwide. Beyond the pain and suffering, violence has a significant economic impact on a country's health, policing and judicial services. Because of the lack of current and comprehensive data in South Africa, local violence-related economic impact studies are largely estimations. Violence-related imaging expenditure, as a component of a public hospital's expenditure, is yet to be determined. Objectives: The goals of this study were to measure the violence-related patient burden on Pelonomi Tertiary Hospital's (PTH) trauma and radiology services, determine the imaging-component cost of violence-related injuries and calculate the financial burden violence has on the hospital's expenditures. Method: From the PTH's trauma unit patient registry, 1380 patients with violence-related injuries were consecutively sampled for 6 months ending 31 December 2017. Imaging investigations were documented and categorised according to the South African National Department of Health's 2017 Uniform Patient Fee Schedule (UPFS). Descriptive analysis and cost calculations were performed using the 2017 UPFS tariff schedule and hospital-specific health efficiency indicators ­ patient-day equivalent and expenditure per patient-day equivalent. Results: Violence-related injuries accounted for 50.64% of all trauma department visits and received a total of 5475 imaging investigations. Violence-related imaging investigations represented 14.81% of all investigations performed by the radiology department in the study period. Overall violence-related admission costs amounted to R35 410 241.85 (8.33% of the hospital's total expenditure), of which 20.08% (R7 108 845.00) was attributed to imaging investigations. Conclusion: Violence-related admissions had a high patient and financial burden on PTH. The pinnacle of healthcare cost saving is violence prevention; however, the cost-conscious radiologist could assist with cost saving if responsible and ethical imaging practices are followed

Inter-observer variability influences the Lugano classification when restaging lymphoma

Background: Lymphoma is an important and potentially curable oncological disease in South Africa. The staging and restaging of lymphoma have evolved over the years, with the latest international consensus guideline being the Lugano classification (LC). Prior to routine implementation of the LC, its robustness in the local setting should be determined. Objectives: To determine the Inter-observer variability in response assignment when applying the LC in patients with lymphoma who were staged and restaged with computed tomography. In case of excessive discordance, specific mitigating measures will have to be taken before and during any proposed implementation of the LC. Method: A total of 61 computed tomography scans in 21 patients were evaluated independentlyby four reviewers according to the LC, of which 21 scans were done at baseline, 21 at initial restaging and 19 at follow-up restaging. A retrospective comparative analysis was performed. Kappa values were calculated to determine agreement between observers. Results: Only a moderate inter-observer agreement of 52% in the overall response classification was demonstrated. The most important sources of discrepancy were inconsistency in the assessment of target lesion regression to normal, determining the percentage change in the summed cross-sectional area of the target lesions and ascribing new lesions as either due to lymphoma or other causes. Conclusion: Implementing the Lugano classification when restaging lymphoma is desirable to improve consistency and to conform to international guidelines. However, our study shows substantial inter-observer variability in response classification, potentially altering the treatment plan. Dedicated training and continuous quality control should, therefore, accompany the process