Outcomes in pediatric patients with documented delays between ileocolic intussusception diagnosis and therapeutic enema attempt: evaluation of reduction efficacy and complication rate.

BACKGROUND: Ileocolic intussusception is considered a pediatric emergency, with concerns for risk of significant morbidity in children with a prolonged intussusception state. Emergent therapy is standard of care, as prior studies have shown poor outcomes in patients with long delays (> 24 h) before intervention. Various factors can result in shorter delays, and there are limited studies evaluating outcomes in these patients. This study aimed to determine if there were differences in reduction success rates associated with short in-hospital time delays. OBJECTIVE: This study is to determine enema success rate and morbidity in patients with documented time delays between intussusception diagnosis and therapeutic enema. MATERIALS AND METHODS: A retrospective evaluation of pediatric patients with intussusception at a single children's hospital between 2007 and 2019 was performed. Patient's records were reviewed for time of symptom onset, radiologic diagnosis, and attempted enema. Ultrasounds and radiographs were reviewed for bowel obstruction, free peritoneal fluid, trapped fluid around the intussusceptum, and absent bowel wall perfusion. Patients were evaluated for efficacy of reduction attempt, requirement for surgical reduction, and complications including bowel resection and bowel perforation. RESULTS: There were 175 cases of ileocolic intussusception requiring enema reduction. Successful reduction occurred in 72.2% (13/18) of cases performed within 1 h of diagnosis; 74.3% (78/105) between 1 and3 h; 73.2% (30/41) between 3 and 6 h; and 81.2% (9/11) with greater than 6 h. Need for bowel resection was not associated with short delays between diagnosis and reduction attempts (p = .07). CONCLUSIONS: There was no difference in intussusception reduction efficacy or complication rate in patients with increasing time between imaging diagnosis of ileocolic intussusception and reduction attempt, including delay intervals up to 8 h.

The Effect of Faster Reporting Speed for Imaging Studies on the Number of Misses and Interpretation Errors: A Pilot Study.

PURPOSE: The purpose of the study was to determine if increasing radiologist reading speed results in more misses and interpretation errors. METHODS: We selected a sample set of 53 abdomen-pelvis CT scans of variable complexity performed at a teaching hospital during the study period. We classified the CT scans into 4 categories based on their level of difficulty, with level 4 representing the most-complex cases. Five attending radiologists participated in the study. We initially established an average baseline reporting time for each radiologist. Radiologists were randomly assigned a set of 12 studies, of varying complexity, to dictate at their normal speed, and a separate set of 12 studies, of similar complexity, to read at a speed that was twice as fast as their normal speed. The major and minor misses were recorded and analyzed. A χ(2) analysis was used to compare the results. RESULTS: Reading at the faster speed resulted in more major misses for 4 of the 5 radiologists. The total number of major misses for the 5 radiologists, when they reported at the faster speed, was 16 of 60 reported cases, versus 6 of 60 reported cases at normal speed; P = .032. The average interpretation error rate of major misses among the 5 radiologists reporting at the faster speed was 26.6%, compared with 10% at normal speed. CONCLUSIONS: Our pilot study found a significant positive correlation between faster reading speed and the number of major misses and interpretation errors.

Job satisfaction of program directors in radiology: a survey of current program directors.

OBJECTIVE: Informal conversations and anecdotal evidence suggest that the job turnover rate among radiology residency program directors is disproportionately high. The purpose of our study was to assess the characteristics of current program directors and determine factors that may be affecting overall job satisfaction and job turnover rate. SUBJECTS AND METHODS: A survey that combined facet-specific measurements and global assessment was sent to current program directors in Accreditation Council for Graduate Medical Education (ACGME)-approved diagnostic radiology programs. An optional free response section was included. Results were collected over 4 weeks. RESULTS: Most of the program directors responded. The mean tenure of current program directors was 6.9 ± 6.7 years (range, 0.5-30 years). Fifty-three percent rated global job satisfaction high, and 6% reported low satisfaction. Sixty-four percent of the respondents were not considering resignation, compared with 13% who were definitely resigning. Program directors in larger programs reported a higher level of satisfaction. Positive interactions with residents and feeling valued by colleagues increased job satisfaction. The greatest source of dissatisfaction from all respondents seemed to be ACGME regulations, which were considered excessive and to change too frequently. The changing format of the board examination and structure of a residency were not the major factors in determining job satisfaction. CONCLUSION: The job satisfaction rate among current program directors is high, likely owing to feelings of fulfillment in working with residents and feeling valued by colleagues. The major source of dissatisfaction appears to stem from ACGME oversight, which is perceived as excessive and having requirements that change too frequently.

The written clinical diagnosis board examination: survey of program director and resident opinions.

OBJECTIVE: The purpose of our study was to assess the perceived value of the American Board of Radiology written clinical diagnosis board examination. MATERIALS AND METHODS: Two online surveys were distributed to diagnostic radiology programs approved by the Accreditation Council for Graduate Medical Education. Program directors were asked about the importance of the examination, and residents were asked about the importance and composition (proportion of repeated questions, known as recalls) of the examination and about preparation strategies. RESULTS: Most of the program directors (122 of 178, 69%) responded. Most of the respondents believed that the examination correlated with their assessment of residents' knowledge, that passing was indicative of a qualified radiologist, and that the examination should not be eliminated. Although most of the program directors believed preparation increased residents' knowledge, they also believed that preparation detracted from reading assignments. Opinion was divided whether the examination should be continued in its present form. The majority of the 171 resident respondents spent most of their time studying recalls, which they believed made up 40-60% of the examination. One half of the residents believed that preparing helped in mastering the body of radiology knowledge, although most believed that core material made up only 20-60% of the examination. A minority of the residents considered passing the examination indicative of a qualified radiologist. Opinion was divided on continuing the examination in its present form. CONCLUSION: Program directors and residents perceived value in the written clinical diagnosis board examination. The American Board of Radiology may need to reevaluate question content when restructuring the new examination.

Preliminary radiology resident interpretations versus final attending radiologist interpretations and the impact on patient care in a community hospital.

OBJECTIVE: At academic institutions, overnight emergency radiology examinations are interpreted by the on-call radiology resident and are reviewed by an attending radiologist in the morning. The objective of our study was to determine the rate of discrepancies between the two interpretations and the possible effect, if any, on patient care. MATERIALS AND METHODS: The preliminary reports for 11,908 emergency diagnostic imaging examinations interpreted after hours by residents over a 3-year period (January 2002-January 2005) were reviewed retrospectively for any discrepancy with the attending radiologist's final interpretation. A discrepancy was noted if verbal notification of the ordering physician was required. The medical charts of the cases for which there was a major discrepancy between the two interpretations were reviewed. The discrepancies were categorized as to the effect on patient morbidity. The resident discrepancy rates were also compared with RADPEER data from our institution. RESULTS: The overall major discrepancy rate was 2.6%. This rate is comparable to RADPEER data, which found a misinterpretation rate of 2.1%. The technique most commonly involved in cases with discrepant interpretations was contrast-enhanced CT of the abdomen and pelvis, with the most common diagnosis related to acute appendicitis (total of 21 cases). The rate of discrepancy was highest for residents who were in their third year of training. The indications for these examinations varied; however, the effect on patient management was no significant effect in 92.8%, some negative effect in 6.9%, and significant negative effect in 0.3%. CONCLUSION: The results of this investigation highlight the minimal discrepancy rate that occurs with overnight resident coverage. Thus, there is no detrimental effect on the quality of patient care from relying on preliminary interpretations made by radiology residents.