Contrasting pediatric specialty provider opinion between contextualized and structured radiology reports

Background: Structured reporting (SR) replaced narrative (free text) reporting and utilizes templated headings and subheadings with findings typically based on the anatomy included in the examination. Its use has been widely advocated by radiology and non-radiology organizations as the new reporting standard. There are, however, shortcomings to SR, such as templated text not addressing a specific clinical indication. Contextual reporting (CR) fills this gap. CR is a type of SR which is tailored to a narrow clinical indication by including pertinent positive and negative findings for that specific clinical entity.

Objective: This study assesses provider preferences for CR as compared to SR in the pediatric practice environment using a survey methodology.

Methods & materials: Surveys with examples of SR and CR reports were sent electronically to two groups. One group was focused on neurological diseases and included pediatric specialists in neurosurgery, neurology, ENT, ED, and ophthalmology (190 people), referred to as the pediatric neuroimaging group. The pediatric neuroimaging group survey contained examples of CR and SR reports of an orbital CT for orbital cellulitis and a head CT for stroke. The other group was focused on gastrointestinal diseases, and included pediatric specialists in gastroenterology, general surgery, and the ED (159 people), referred to as the pediatric gastrointestinal (GI) imaging group. The pediatric GI imaging group survey contained example reports of an abdominal CT for appendicitis and an MRI enterography for Crohn's disease. Surveys utilizing a 5-point Likert scale were analyzed via Fischer's exact test with a p-value deemed statistically significant at less than 0.05.

Results: 349 individuals were contacted to participate in the survey. There were 81 (23 %, 81/349) survey respondents; 41 (22 %, 41/190) from the neuro group, and 40 (25 %, 40/159) from the GI group. 56 % (45/81) of all respondents preferred CR reports over traditional SR reports, while 29 % (23/81) did not. Most respondents (59 %, 48/81) indicated that CR reports are easier to interpret than traditional SR reports. Respondents from the pediatric neuroimaging group favored CR reports to a lesser degree (44 %, 36/81) compared to respondents from the pediatric GI imaging group (68 %, 55/81).

Conclusions: We learned from this survey that it would be beneficial to be very intentional about selecting clinical indications where CR would be most valued rather than trying to develop CR for any specific clinical indication. The study results indicate it is reasonable to continue further efforts at exploring the utility of contextualized reports.