Aim To assess the current level of accuracy in interpreting radiological findings of necrotising enterocolitis (NEC) on an abdominal radiograph.
Methods High resolution printed images of 6 different abdominal radiographs were presented to doctors working on 7 neonatal units which make up our Neonatal Network. The images were selected by 3 neonatal consultants at the surgical centre. The images were presented as a slide show in 5 units, for additional clarity.
Results 67 doctors took part in the survey; 52% senior house officers (SHOs), 33% paediatric or neonatal registrars and 15% consultant were neonatal or paediatric consultants. The average confidence rating for both training and interpretation of abdominal radiographs was 4/10 for juniors and 8/10 for consultants. 29% of juniors and 58% of consultants correctly identified the pathology. 63% of the tertiary surgical centre respondents made correct diagnoses compared with 29% respondents at non-surgical centres. One radiograph that demonstrated severe NEC was correctly identified by 85% of all respondents. Three radiographs demonstrating pneumoperitoneum were correctly identified by 18–28% of respondents. A normal radiograph was correctly identified by 9% of respondents and 67% of respondents diagnosed it to be NEC. Overall, when a diagnosis of NEC was made (even if incorrect) 92% instigated appropriate clinical management. Abdominal radiographs were referred to a senior member of the neonatal or surgical team in 77% of cases and only referred to the radiology team in 1.7% of cases.
Conclusion Interpretation of neonatal abdominal radiographs is an important tool in providing high quality neonatal care. Many junior respondents reported that they lacked confidence when reviewing abdominal radiographs and also reported minimal formal training. In view of the survey findings, we recommend regular integrated neonatal-surgical radiology meetings within the Network. This could include video-linked conference calls. In addition, abdominal radiographs should ideally be reviewed by two senior team members that include a consultant. If the interpretation still remains unclear, it should be discussed with the tertiary surgical centre. We aim to re-evaluate improvement levels a year from implementation of the recommendations.