Scientific Session 11 — SS11: Efficacy/Administration/Informatics - EducationTuesday, May 7, 2019
2871. Rate of Radiology Resident Recognition of Non-Accidental Trauma: How Well do Residents Perform?
Sharma P*, Rajderkar D, Slater R, Batmunh B, Mancuso A. University of Florida, Gainesville, FL
Address correspondence to P. Sharma (email@example.com)
Objective: The identification of nonaccidental trauma by the “on-call” radiology resident is of the utmost importance because it is the resident who must notify clinicians of this concern and facilitate potential removal of the child from harm. The resident’s role in identifying child abuse has not previously been studied.
Materials and Methods: The Emergent/Critical Care Imaging SIMulation (WIDI SIM) is a strategically designed computer-aided simulation of an emergency imaging experience that has been rigorously tested and proven to be a reliable means for assessing radiology resident preparedness to competently and independently cover radiology call. The residents are provided with 65 cases of varying difficulty, including normal studies. One case requires the resident to accurately identify skeletal and/or cross-sectional imaging findings of nonaccidental trauma. The residents respond with free text, which is then scored by faculty members with a robust grading rubric. Missed cases are then categorized by observation error and/or interpretative errors.
Results: A total of 1002 radiology residents, from programs across the country, were given a case of nonaccidental trauma with the WIDI simulation web-based test platform between 2014 and 2018. The diagnosis of child abuse was consistently undercalled by radiology residents being tested for call readiness. Over 5 years, the average correctly called score was 39.2%. Correctly called score averages per year ranged from 1% to 81%. In year 1, 61% of residents correctly called nonaccidental trauma, with a total of 101 participants. In year 2, 127 residents participated with only 20% answering correctly. In year 3, there were 186 participants with 81% correctly diagnosing nonaccidental trauma. In year 4, when provided with a history of cyanosis and given a chest x-ray with multiple posterior rib fractures, only 1% of 264 residents accurately diagnosed nonaccidental trauma. In year 5 of testing, when given an MRI of abusive head trauma, 33% correctly diagnosed the case. Residents from various stages of training were tested. Cases with leading histories provided accounted for a higher correct call rate.
Conclusion: Radiology residency is lacking in teaching residents to accurately recognize and report child abuse. This limitation has great implications for programs in which a radiology attending is not present at night because it raises the concern that child abuse will be missed by residents taking overnight call. Missing a case of child abuse can have lethal consequences. Furthermore, this finding brings into question whether graduating radiologists are competent in their ability to recognize nonaccidental trauma.