Medical cost containment: Analysis of dual orthopedic/radiology interpretation of X-rays in the trauma patient

Objective: The purpose of this study was to investigate the timing, accuracy, clinical impact, and cost of dual orthopedic and radiology interpretation of orthopedic trauma roentgenograms. Design: The investigation was performed in a combined retrospective-prospective fashion. Materials and Methods: Records of 25 retrospective and 25 prospective trauma patients with femoral fractures were reviewed and the radiology and orthopedic roentgenographic interpretations were compared in terms of four criteria: timing, accuracy, clinical impact, and cost. Measurements and Main Results: The orthopedic surgeons documented reading 85% of 272 acute roentgenograms in the retrospective patients and 89% of 181 roentgenograms in the prospective patients. The orthopedist readings were immediate, 100% accurate, had significant impact on the patients' care, and incurred no additional cost. The radiologists read 59 and 75% of the retrospective and prospective roentgenograms, respectively. The accuracy rate was 94 and 96%, the time to reading averaged 7 and 4.6 days, and the estimated cost averaged $393 and $200 per patient, respectively. The radiologist readings had no impact on patient care. Conclusion: This study suggests that routine radiology consultation of musculoskeletal films read by the orthopedic surgeon is not required for the care of the acute trauma patient.