Huge shortfall of pediatric radiologists puts lives at risk

The shortages, which are particularly acute in the smaller (regional) hospitals in the UK, and the resulting lack of expertise also means that hard-to-recognize injuries are missed, putting other babies at risk, according to the Sunday Times.

The report was “fairly accurate,” Dr. Owen Arthurs, a pediatric radiologist at Great Ormond Street (CIS) Hospital in London and associate professor of radiology at University College London CIS Institute of Child Health, told on June 28.

dr. Owen Arthurs. Photo Courtesy of Great Ormond Street Hospital

“There are actually two issues — one is the availability of pediatric radiologists to report on day-to-day clinical work due to a national shortage, etc,” he said. “And the other is a shortage of those willing to come forward to give expert testimony in court.”

Most centers don’t have 24/7 access to a specialist pediatric radiologist and some centers don’t have access at all, Arthurs told the Sunday Times. “It’s not that they don’t try their best, they do their best under very limited circumstances.”

He said hospitals (or groups) of the National Health Service (NHS) were often hesitant to push their experts forward to double-check diagnoses from smaller hospitals, as they were likely to get caught up in lawsuits and a “perception that doing These kinds of cases are associated with negative media coverage.”

Missed rib fractures

In the Sunday Times article, Dr. Kath Halliday, a pediatric radiologist at Nottingham University Hospitals, reported a case where rib fractures were not seen on a chest X-ray of a baby being examined for coughing.

“The pediatrician was quite inexperienced and didn’t see them. He was looking for signs of infection and not really rib fractures. The baby went home and that night that baby was beaten up so much that they’re never the same again,” he said. they.

Halliday said that in the “vast majority” of cases, the diagnosis is made by two experienced clinicians, in accordance with the guidelines of the UK’s Royal College of Radiologists, but sometimes it didn’t.

dr. Kath Halliday.

“It’s probably easiest to overdiagnose [abusive injuries] because the consequences of underdiagnosis are so bad. The consequences of overdiagnosis are also bad, but they’re not as obvious as a dead baby coming in after you’ve just sent them home,” she noted.

The shortage of radiologists is particularly acute in pediatrics, with 55% of UK vacancies unfilled by 2020.

“There’s a real pressure to make decisions very quickly. It’s a real concern that some kids are being taken away from their families when they shouldn’t be,” Dr. Adam Oates, a pediatric radiologist at Birmingham Children’s Hospital, told the Sunday Times.

Some parts of the UK have very few specialists. North East England has just five pediatric radiologists, nine times fewer per capita than London, where there are 70. The area also has one of the highest rates of screening young babies for physical abuse, with one in 83 assessed last year. the article stated.

According to the Sunday Times, “In one case in the region, radiologists diagnosed small haemorrhages in the brain that were interpreted as possibly indicating abuse in a one-week-old baby. They were discovered in an MRI scan after the baby went to Child Protective Services.” due to an unexplained bruise The baby had had a difficult vaginal delivery and, after months of separation from his parents, a court-appointed brain imaging expert said the suspected bleeding was likely normal signs from birth.

Real problems at smaller hospitals

Oates said problems tended to occur in smaller hospitals. “If you go to a small general district hospital, the radiologists there won’t have the same level of experience… detecting fractures in children is not the same as in adults because the immature bones are different and therefore things that look like fractures may not be able to do fractures.” to be.”

He thought there was a “tendency to overwrite rib fractures,” especially since they are “very subtle” and can indicate a baby’s trembling. Inexperience increases the tendency to reject explanations for fractures, he added.

“I have been in a situation where the parents’ story seemed very unlikely and abuse was suspected, but CCTV footage was subsequently found showing a very plausible accidental cause of an injury,” he told the Sunday Times, adding that he hoped that recruiting more counselors to take on expert judicial work would reduce delays in correcting misdiagnosis.

The British Association of Social Workers said it was “concerned about the shortage of radiologists, as social workers do not work in silos, they work in multidisciplinary teams, and experienced radiologists are vital in diagnosing skeletal examinations to determine whether a child is intentionally abused or not.”

The UK Department of Health and Social Care said it had begun tackling the shortfall. “The number of physicians working in clinical radiology has increased by more than 25 percent in the past five years,” the organization told the paper.

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