Article Figures & Data
Figures
- Figure 1.
Study results.
Tables
- Table 1.
Description of Radiographs Obtained by Primary Care Clinicians and Those for Which Radiologist Referral Reading Was Hypothetically Declined
Body Area % of Total Radiographs % Referral Declined Chest 29.4 (410) 27.1 (111) Lower extremity 27.7 (386) 49.0 (189) Upper extremity 23.9 (333) 50.8 (169) Spine 7.6 (106) 30.2 (32) Abdomen 3.9 (55) 38.2 (21) Face/head 3.1 (43) 27.9 (12) Pelvis 2.7 (37) 29.7 (11) Rib/sternum/clavicle 1.7 (23) 34.8 (8) Total 100 (1393) 40 (553) - Table 2.
Percentage Concordance between Primary Care Clinician and Radiologist Readings, Referral Hypothetically Requested or Declined
Body Area N % Concordance All Readings % Concordance When Referral Requested % Concordance When Referral Declined P value* Chest 410 67.3 (276/410) 62.5 (187/299) 80.2 (89/111) <.001 Lower extremity 386 78.0 (301/386) 73.1 (144/197) 83.1 (157/189) .017 Upper extremity 333 80.2 (267/333) 72.6 (119/164) 87.6 (148/169) <.001 Both extremities 719 79.0 (568/719) 72.9 (263/361) 85.2 (305/358) <.001 Spine 106 61.3 (65/106) 60.8 (45/74) 62.5 (20/32) .869 Abdomen 55 58.2 (32/55) 52.9 (18/34) 66.7 (14/21) .305 Face/head 43 69.8 (30/43) 61.3 (19/31) 91.7 (11/12) .010 Pelvis 37 62.2 (23/37) 57.7 (15/26) 72.7 (8/11) .364 Rib/sternum/clavicle 23 69.6 (16/23) 66.7 (10/15) 75.0 (6/8) .670 Total 1393 72.5 (1010/1393) 66.3 (557/840) 81.9 (453/553) <.001 * χ2 test for difference in proportion of concordance in referral hypothetically requested or declined.
Case Body Area Clinician Reading Radiologist Reading Change in Care Outcome 1 Foot Normal 2nd metatarsal stress fracture Follow-up visit scheduled* Continued pain at follow-up visit with normal radiographs 17 months later 2 Hand Normal Nondisplaced intra-articular fracture at base of 2nd metacarpal Cast applied* Continued to have pain 9 months later despite appropriate care 3 Left ribs and PA chest Normal Nondisplaced 5th, 6th and 7th rib fractures New prescription for pain medication* Pain improved at 5-week follow-up visit 4 Foot Normal Nondisplaced 5th proximal phalangeal shaft fracture Gym excuse for 3 weeks* No further follow up documented 5 Ankle Normal Impacted calcaneus fracture Repeat radiographs* No calcaneal pain 9 weeks later 6 Hand Normal Possible fracture of DIP dorsal spur Additional office visit repeat radiographs* Although patient free of pain or swelling, repeat radiographs were obtained. 7 PA and lateral chest Lung infiltrate No acute pulmonary disease Cancelled possible CT* Cough resolved 8 Lumbar spine, AP and lateral ′No acute disease′ Possible spondylolysis recommended additional radiographs Additional radiographs† No change in care for back pain 9 Abdomen Normal 6-mm nodule, base of lung Additional radiographs† ′Nodule′ not seen on repeat radiographs 10 PA and lateral chest Normal Bilateral lung nodules Additional radiographs† One nodule was nipple, other was not identified 11 PA and lateral chest Normal 1-cm lung nodule Additional radiographs† No further evaluation 12 Shoulder Normal Possible mild acromioclavicular subluxation, recommended additional radiographs Additional radiographs† Complete resolution of muscular shoulder strain, no change in care of shoulder 13 PA and lateral chest Normal Possible parenchymal opacity Administrative effort to obtain old radiographs for comparison‡ Possible parenchymal opacity was second rib 14 PA and lateral chest Normal Possible lung nodule Administrative effort to obtain old radiographs for comparison‡ Nodule stable for more than 2 years 15 Hand§ Normal Fracture at base of 5th proximal phalanx None documented Unknown 16 Thumb§ Normal Possible nondisplaced Salter-Harris type II fracture of distal phalanx None documented Unknown 17 Ankle§ Normal Possible medial malleolar avulsion fracture None documented Unknown 18 Thumb§ Normal Possible nondisplaced Salter-Harris type II fracture of distal phalanx None documented Unknown PA, posteroanterior.
* Presumed or documented 1 telephone contact for each case.
† Presumed or documented 2 telephone contacts for each case.
‡ Presumed or documented 3 telephone contacts for each case.
§ No follow up documented.
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