Advertisement

Hernia

, Volume 23, Issue 5, pp 987–994 | Cite as

Importance of the physical exam: double-blind randomized controlled trial of radiologic interpretation of ventral hernias after selective clinical information

  • D. V. Cherla
  • K. BernardiEmail author
  • K. J. Blair
  • S. S. Chua
  • J. P. Hasapes
  • L. S. Kao
  • T. C. Ko
  • E. J. Matta
  • M. L. Moses
  • K. G. Shiralkar
  • V. R. Surabhi
  • V. S. Tammisetti
  • C. P. Viso
  • M. K. Liang
Original Article
  • 92 Downloads

Abstract

Purpose

Increasingly, radiologic imaging is obtained as part of the pathway in diagnosing ventral hernias. Often, radiologists receive incomplete or incorrect clinical information from clinicians. Objective: The aim of the study is to determine if clinical exam findings alter radiological interpretation of ventral hernias on CT.

Methods

This is a single-institution double-blind, randomized trial. All patients with a recent abdominal/pelvic CT scan seen in various surgical clinics were enrolled. A surgeon blinded to the CT scan findings performed a standardized physical examination and assessed for the presence of a ventral hernia. Seven independent radiologists blinded to the study design reviewed the scans. Each radiologist received one of three types of clinical exam data per CT: accurate (correct), inaccurate (purposely incorrect), or none. Allocation was random and stratified by the presence of clinical hernia. The primary outcome was the proportion of radiologic hernias detected, analyzed by chi square.

Results

115 patients were enrolled for a total of 805 CT scan reads. The proportion of hernias detected differed by up to 25% depending on if accurate, no, or inaccurate clinical information was provided. Inaccurate clinical data in patients with no hernia on physical exam led to a significant difference in the radiologic hernia detection rate (54.3% versus 35.7%, p = 0.007). No clinical data in patients with a hernia on physical exam led to a lower radiologic hernia detection rate (75.0% versus 93.8%, p = 0.001).

Conclusions

The presence and accuracy of clinical information provided to radiologists impacts the diagnosis of abdominal wall hernias in up to 25% of cases. Standardization of both clinical and radiologic examinations for hernias and their reporting are needed.

Trial registration

Clinicaltrials.gov, Number NCT03121131, https://clinicaltrials.gov/ct2/show/NCT03121131.

Keywords

Umbilical hernia Ventral hernia Incisional hernia Radiologic diagnosis Radiologic accuracy Provider information 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest or anything to disclose. DC: declares no conflict of interest. KB: declares no conflict of interest. KB: declares no conflict of interest. SC: declares no conflict of interest. JH: declares no conflict of interest. LK: declares no conflict of interest. TK: declares no conflict of interest. EM: declares no conflict of interest. MM: declares no conflict of interest. KS: declares no conflict of interest. VS: declares no conflict of interest. VT: declares no conflict of interest. CV: declares no conflict of interest. ML: declares no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights

This experiments complies with the current laws of the United States on medical research.

Informed consent

With institutional review board oversight and approval, all patients received a written consent of participation, however, for participating radiologists a written consent was waived. Radiologist received a letter of information explaining the broadscope of the project, voluntary nature of participation, risks and benefits, and contact information in the event of questions or to withdraw from the study.

Supplementary material

10029_2018_1856_MOESM1_ESM.docx (35 kb)
Supplementary material 1 (DOCX 35 KB)
10029_2018_1856_MOESM2_ESM.docx (35 kb)
Supplementary material 2 (DOCX 35 KB)

References

  1. 1.
    Berdahl CT, Vermeulen MJ, Larson DB, Schull MJ (2013) Emergency department computed tomography utilization in the United States and Canada. Ann Emerg Med 62(5):486–496CrossRefGoogle Scholar
  2. 2.
    Chin JY, Goldstraw E, Lunniss P, Patel K (2012) Evaluation of the utility of abdominal CT scans in the diagnosis, management, outcome and information given at discharge of patients with non-traumatic acute abdominal pain. Br J Radiol 85(1017):e596–e602CrossRefGoogle Scholar
  3. 3.
    Khalilzadeh O, Rahimian M, Batchu V, Vadvala HV, Novelline RA, Choy G (2015) Effectiveness of second-opinion radiology consultations to reassess the cervical spine CT scans: a study on trauma patients referred to a tertiary-care hospital. Diagn Interv Radiol 21(5):423–427CrossRefGoogle Scholar
  4. 4.
    Zen E, Yousem DM, Carone M, Lewin JS (2010) Second-opinion consultations in neuroradiology. Radiology 255(1):135–141CrossRefGoogle Scholar
  5. 5.
    Cheng T, Dumire R, Golden S, Gregory J (2013) Impact on patient care of discordance in radiology readings between external overnight radiology services and staff radiology readings at a level 1 trauma center. Am J Surg 205(3):280–282CrossRefGoogle Scholar
  6. 6.
    Eakins C, Ellis WD, Pruthi S et al (2012) Second opinion interpretations by specialty radiologists at a pediatric hospital: rate of disagreement and clinical implications. AJR Am J Roentgenol 199(4):916–920CrossRefGoogle Scholar
  7. 7.
    CNN (2008) Radiologists read scans better if they have patient’s photo. http://www.cnn.com/2008/HEALTH/12/02/healthmag.scan.photo/index.html?iref=newssearch. Accessed Feb 2017
  8. 8.
    Grady AT, Sosa JA, Tanpitukpongse TP, Choudhury KR, Gupta RT, Hoang JK (2015) Radiology reports for incidental thyroid nodules on CT and MRI: high variability across subspecialties. AJNR Am J Neuroradiol 36(2):397–402CrossRefGoogle Scholar
  9. 9.
    Alexander K (2010) Reducing error in radiographic interpretation. Can Vet J 51(5):533–536PubMedPubMedCentralGoogle Scholar
  10. 10.
    Doubilet P, Herman PG (1981) Interpretation of radiographs: effect of clinical history. AJR Am J Roentgenol 137(5):1055–1058CrossRefGoogle Scholar
  11. 11.
    ClinicalTrials.gov. (2017) https://clinicaltrials.gov/. Accessed Jan 2017
  12. 12.
    Enhancing the Quality and Transparency of Health Research (2010) Equator network. http://www.equator-network.org/reporting-guidelines/consort/. Accessed Mar 2017
  13. 13.
    Holihan JL, Flores-Gonzalez JR, Mo J, Ko TC, Kao LS, Liang MK (2017) A prospective assessment of clinical and patient-reported outcomes of initial non-operative management of ventral hernias. World J Surg 41(5):1267–1273CrossRefGoogle Scholar
  14. 14.
    Holihan JL, Karanjawala B, Ko A et al (2016) Use of computed tomography in diagnosing ventral hernia recurrence: a blinded, prospective, multispecialty evaluation. JAMA Surg 151(1):7–13CrossRefGoogle Scholar
  15. 15.
    Kohavi R, Provost F (1998) Glossary of terms. Mach Learn 30(2/3):271–274CrossRefGoogle Scholar
  16. 16.
    Brady A, Laoide RO, McCarthy P, McDermott R (2012) Discrepancy and error in radiology: concepts, causes and consequences. Ulster Med J 81(1):3–9PubMedPubMedCentralGoogle Scholar
  17. 17.
    Tillack AA, Borgstede JP (2013) An evaluation of the impact of clinically embedded reading rooms on radiologist-referring clinician communication. J Am Colloid Radiol 10(5):368–372CrossRefGoogle Scholar
  18. 18.
    Welch HG, Prorok PC, O’Malley AJ, Kramer BS (2016) Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness. N Engl J Med 375(15):1438–1447CrossRefGoogle Scholar
  19. 19.
    Renfrew DL, Franken EA, Berbaum KS et al (1992) Error in radiology: classification and lessons in 182 cases presented at a problem case conference. Radiology 183(1):145–150CrossRefGoogle Scholar
  20. 20.
    Goodenough CJ, Ko TC, Kao LS et al (2015) Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: hernia expectation rates in intra-abdominal surgery (the HERNIA Project). J AM Colloid Surg 220(4):405–413 (Epub 2015 Jan 2) CrossRefGoogle Scholar
  21. 21.
    Nardi M Jr., Millo P, Brachet Contul R et al (2017) Laparoscopic ventral hernia repair with composite mesh: analysis of risk factors for recurrence in 185 patients with 5 years follow-up. Int J Surg 40:38–44 (Epub ahead of print)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • D. V. Cherla
    • 1
    • 2
  • K. Bernardi
    • 1
    • 2
    Email author
  • K. J. Blair
    • 3
  • S. S. Chua
    • 3
  • J. P. Hasapes
    • 3
  • L. S. Kao
    • 1
    • 2
  • T. C. Ko
    • 1
    • 2
  • E. J. Matta
    • 3
  • M. L. Moses
    • 1
  • K. G. Shiralkar
    • 3
  • V. R. Surabhi
    • 3
  • V. S. Tammisetti
    • 3
  • C. P. Viso
    • 1
  • M. K. Liang
    • 1
    • 2
  1. 1.Department of Surgery, Lyndon Baines Johnson HospitalUniversity of Texas Health Science Center at HoustonHoustonUSA
  2. 2.Center for Surgical Trials and Evidence-Based PracticeUniversity of Texas Health Science Center at HoustonHoustonUSA
  3. 3.Radiology DepartmentUniversity of Texas Health Science Center at HoustonHoustonUSA

Personalised recommendations