Appropriateness of musculoskeletal soft tissue swelling ultrasound scans

ABSTRACT

This audit's purpose was to assess the appropriateness of referrals from primary and secondary care for soft tissue lumps and bumps ultrasounds (US) that are being performed in a university teaching hospital imaging department and compare against the British Sarcoma Group (BSG) national guidelines. This is on the background of increasing referrals for ultrasound scans of soft tissue lumps with limited clinical information in the face of increasing workload in the imaging department. This was a retrospective study, analysing data for all US performed for soft tissue swelling - over a one-month period. We focused on all US undertaken in the imaging department for June 2019 (pre-COVID) allowing for a 24 month follow-up period. Indications and findings were recorded. The requests were assessed regarding appropriateness by comparing to NICE and BSG guidelines. 200 ultrasound scans were undertaken during the one month period;14 paediatric patients were excluded from the data. The majority of referrals were from primary care (92%). Of the 186 cases analysed, 102 cases (54%) did not contain any appropriate clinical information as per the guidelines and no descriptive features were mentioned. Of the 81 cases (44%) that did contain relevant clinical information, 14 cases (17%) mentioned clinical features that, according to the guidelines, did not require ultrasound imaging and hence were also inappropriate. This audit shows the significant proportion of inappropriate requests from primary care. There was a lack of relevant clinical information on requests for US soft tissue, making it difficult to ascertain which patients need to be offered a direct access US in the required twoweek time frame. Considerations for improving the quality of referrals include presenting the audit within primary care teams to enhance referrer education and ratifying an US request system with a flowsheet proforma to ameliorate the referral process.