Recommendations in Second Opinion Radiology Reports of Abdominal Imaging Examinations: Referring Clinicians' Compliance and Diagnostic Outcome

OBJECTIVE. The purpose of this study was to investigate how often referring clinicians comply with recommendations in second opinion radiology reports of abdominal imaging examinations, determinants of their compliance, and diagnostic outcome of recommendations. MATERIALS AND METHODS. This retrospective study included 2225 consecutive tertiary center second opinion radiology reports of abdominal imaging examinations performed at outside institutions. RESULTS. Referring clinicians followed 163 of 307 recommendations, corresponding to a frequency of 53.1% (95% CI, 47.5-58.6%). Logistic regression analysis showed no significant association between referring clinicians' compliance and any of the investigated variables, which included patient age, sex, hospitalization status, indication for reinterpretation, strength and clarity of the recommendation, whether the recommendation was made because of perceived insufficient quality of the original imaging examination, and experience of the radiologist who performed the reinterpretation. Of the 275 recommendations that were eligible for a subanalysis on diagnostic outcome, 147 (53.5%) were followed by the referring clinicians and yielded a malignant diagnosis in 30 cases (20.4%). Of the 128 recommendations that were not followed, the advice would have yielded a malignant diagnosis in four cases (3.1%) if it had been followed. The proportions of malignant diagnoses were significantly different between the recommendations that were followed and those that were not (p < 0.001), favoring a higher proportion of the former. CONCLUSION. Recommendations in second opinion reports of abdominal imaging examinations are frequently followed by referring clinicians, but it remains unclear as to which factors influence their compliance. These recommendations lead to a malignant diagnosis in a considerable number of cases.