Assessing the Necessity and Cost-effectiveness of Radiology Reports for Plain Hand Radiographs in Outpatient Clinics.

Abstract

Purpose: The purpose of this study was to determine the necessity and cost-effectiveness of radiologists' interpretation of plain hand radiographs for diagnosing and managing different hand pathologies in the plastic surgery outpatient clinic setting. Methods: Through a retrospective cohort study, we identified new patient encounters from January 2021 to December 2022 in an outpatient hand clinic. We included patients with radiology reports that were submitted subsequent to the surgeon's consult note in clinic. Plastic surgeons' interpretations were compared with radiology reports, and findings were categorized as concordant, discrepant (different with no impact on management), or discordant (different with an impact on management). Analysis included radiograph type, underlying mechanism, site of pathology, and hand fellowship training for surgeons. Direct cost was calculated using billing code fees. Results: A total of 241 cases were included in the study: 187 were concordant (77.6%), 53 were discrepant (22%) and only one was discordant (0.4%). Trauma was the predominant reported mechanism (90.5%). Most pathologies were in the phalanges (53.5%), followed by metacarpals (30.7%) and carpals (15.8%). Univariate analysis demonstrated no significant association between radiograph type (P = .829), underlying mechanism (P = .172), site of pathology (P = .482), surgeon's training (P = .551) and concordance with radiology reports. Total direct cost of radiographs reporting in this study was 8477 CAD. Conclusion: The study identified high concordance rates of hand radiograph findings between plastic surgeons and radiologists, with radiology reports rarely impacting patient management. Given the significant patient volume in plastic surgery hand clinics, these findings prompt further considerations in optimizing cost-effective diagnostic practices.