Assessment of joint review of radiologic studies by a primary care physician and a radiologist.

OBJECTIVES: To assess whether the joint review of radiologic studies by the primary care physician and the radiologist affects patient care and health care costs. DESIGN: Prospective study. SETTING: Student health clinic at a university hospital. PATIENTS: University students seen during acute care visits. INTERVENTION: Joint weekly review of all radiologic studies ordered at the student health clinic between July 1992 and June 1993 by a staff radiologist and internist. MEASUREMENTS AND MAIN RESULTS: The outcome measures were: (1) change of radiologic diagnosis after review process and its effect on patient management; (2) expenses saved or incurred by the review process. Of 323 films ordered, 305 were reviewed, resulting in revisions of 23 (8%) of the initial readings. Sixteen revisions (5%) led to a change in patient management; the remainder were clinically insignificant. In these 16 cases, cancellation or simplification of further workup resulted in savings of $1,967. The cost for extra physician time was $5,499. Thus, the review process incurred a net cost of $3,532. Except for the reduction in diagnostic studies, no therapeutic benefit for the patients could be identified. Film readings in our radiology department were conservative, with a positive predictive value of 85% and a negative predictive value of 99.7%. CONCLUSIONS: Routinely reviewing every radiologic study did not affect patient outcome in an outpatient clinic with low prevalence of disease. Given our radiologists' conservative film-reading practice, a review of only abnormal studies may prove more cost-effective in a healthy population. This type of assessment has implications for improving the efficiency of a changing health care system.

Group C beta-hemolytic streptococci causing pharyngitis and scarlet fever.

After a young woman had scarlet fever associated with group C beta-hemolytic streptococcal pharyngitis, we reviewed all cases of pharyngitis treated at a student health clinic during that semester. From 541 cases of pharyngitis, 34 cultures yielded group C Streptococcus. The patients who harbored group C organisms were similar to the patients with group A streptococcal pharyngitis in the presence of fever, exudate, and cervical adenopathy. The severity of symptoms and the demonstration of scarlet fever developing from infection with this organism supports antibiotic treatment of patients with group C streptococcal pharyngitis.

Late appearance of skin rash in Rocky Mountain spotted fever.

Late appearance of a skin rash in Rocky Mountain spotted fever is associated with a high mortality. Our patient's rash appeared 14 days after the onset of illness, during his recovery. In endemic areas one must rely on clinical clues other than rash to raise the suspicion of Rocky Mountain spotted fever. The combination of fever, headache, myalgias, marked left shift in the differential white blood cell count, severe thrombocytopenia, and hyponatremia all help to suggest the correct diagnosis early in the course of the illness.