Computed tomography in ventral hernia diagnosis: have we improved? A quality improvement initiative

Previous studies suggest that agreement between readers of computed tomography (CT) scans for the diagnosis of a ventral hernia (VH) is poor (32% agreement, κ = 0.21). Recommendations were developed by surgeons and radiologists after determining common reasons for disagreement among CT reviewers; ho...

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Bibliographic Details
Published in:The Journal of surgical research 2018-04, Vol.224, p.97-101
Main Authors: Holihan, Julie L., Cherla, Deepa, Blair, Katherine J., Chua, Steven S., Hasapes, Joseph P., Matta, Eduardo J., Shiralkar, Kaustubh G., Surabhi, Venkateswar R., Tammisetti, Varaha S., Ko, Tien C., Liang, Mike K.
Format: Article
Language:English
Subjects:
Adult
Aged
Computed tomography
Female
Hernia
Hernia, Ventral - diagnostic imaging
Humans
Interobserver reliability
Male
Middle Aged
Prospective Studies
Quality Improvement
Tomography, X-Ray Computed - methods
Ventral
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Summary:Previous studies suggest that agreement between readers of computed tomography (CT) scans for the diagnosis of a ventral hernia (VH) is poor (32% agreement, κ = 0.21). Recommendations were developed by surgeons and radiologists after determining common reasons for disagreement among CT reviewers; however, the long-term effect of adoption of these recommendations has not been assessed. The aim of this quality improvement (QI) project was to determine whether the incorporation of recommendations developed by surgeons and radiologists improves agreement among reviewers of CT scans in diagnosing a VH. A prospective cohort of patients, with a CT scan of the abdomen and pelvis in the past 1 y, attending a surgery clinic at a single institution was enrolled. Enrolled subjects underwent a standardized physical examination by a trained hernia surgeon to determine the likelihood of a clinical VH (no, indeterminate, or yes). The QI intervention was the distribution and implementation of previously described recommendations. After a year of intervention, independent radiologists assessed patients' CT scans for the presence or absence of a VH. Percent agreement and kappa were calculated to determine interobserver reliability. In-person discussion on scans with disagreement was held, and the results were used as a “gold standard” to calculate sensitivity, specificity, positive, and negative predictive values for CT scan diagnosis of a VH. A total of 79 patients were included in the study. After QI intervention, seven radiologists agreed on 43% of the scans, and κ was 0.50 (P 
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2017.11.055