After-hours emergency radiology CT reporting by radiology registrars at an Australian level 1 trauma centre: A review of discrepancies between preliminary and final reports.

INTRODUCTION: There is reliance on radiology registrar reporting of after-hours CT scans in many public hospitals across Australia and New Zealand. This study evaluates the extent and nature of CT reporting discrepancies after-hours by comparing trainee preliminary reports with consultant finalised reports. METHODS: A retrospective review of all after-hours CT scans between January and December 2014 by radiology trainees at a level 1 trauma centre was performed. Discrepancies were classified as major or minor, by year level of trainee, time of report and scan type (Trauma vs. Non-Trauma). Major discrepancies were investigated to assess if they led to increased morbidity, mortality or a change in treatment. RESULTS: 17,948 after-hours CT scans were performed. A total of 1235 preliminary reports required addendums (discrepancy rate of 6.9%). There were 630 Trauma and 605 Non-Trauma studies. There were 56 major (0.3%) and 1179 minor (6.6%) discrepancies. Of the 56 major discrepancies there were 12 (0.3%) in the Trauma and 44 (6.6%) in the Non-Trauma groups. There were no adverse patient outcomes due to any major discrepancy. There were more minor discrepancies in reports of Trauma CTs compared to Non-Trauma (P ≤ 0.0001). No relationship between the time of report issued and discrepancy rate (P = 0.811) was observed. There was a lower discrepancy rate the more experienced the registrar from year 2 to advanced fellowship (P = 0.003). CONCLUSION: The discrepancy rates of after-hours CT trainee reports were lower at this institution compared to international literature (6.9% vs. 7.7%). The majority of preliminary trainee reports were accurate with no increased morbidity or mortality resulting from major discrepancies.

The Safety of Continuing Therapeutic Anticoagulation During Inferior Vena Cava Filter Retrieval: A 6-Year Retrospective Review from a Tertiary Centre.

PURPOSE: Assess the safety of inferior vena cava (IVC) filter retrieval in patients taking anticoagulation, compared to a non-anticoagulated cohort. MATERIALS AND METHODS: Single-centre retrospective analysis of patients who underwent IVC filter retrieval between January 2012 and February 2018. Information about patient demographics, anticoagulation, tilt, major and minor complications was collected. Major complications were defined as: IVC injury from the filter retrieval, retained fragment of filter, filter fracture and filter embolisation. Minor complications were defined as: neck haematoma and puncture site infection. RESULTS: Total of 357 patients (age 18-95, Male: 231) underwent IVC filter retrieval, comprising of Cook Celect Platinum, Cook Celect, and ALN-branded filters. Of these 182 patients were on anticoagulation and 175 patients were not on anticoagulation, based on the indication for the filter (thrombosis or prophylaxis) and at the discretion of the referring unit who were managing the anticoagulation. IVC filter retrieval was technically successful in 349 patients. Five major complications (1.4% of retrievals) were recorded and no minor complications (0% of retrievals). In the anticoagulation cohort, there were two major complications (1.1% of retrievals) both related to IVC injury. In the non-anticoagulated cohort, there were three major complications (1.7% of retrievals) relating to filter embolisation, IVC injury, and filter fracture. CONCLUSIONS: IVC filter retrieval is a safe procedure with a low complication rate. Being on anticoagulation does not increase the risk of a major complication or change the management of major complication compared with a non-anticoagulated cohort. IVC filter retrieval is safe to perform in patients currently taking prophylactic or therapeutic anticoagulation based on our cohort. LEVEL OF EVIDENCE: Level 3, retrospective cohort study.