A retrospective review of crisis events in diagnostic radiology: an analysis of frequency, demographics, etiologies, and outcomes.

OBJECTIVE: The aim of this study was to determine the underlying characteristics of inpatients sustaining crisis events in the radiology department (RD).

METHODS: This is a retrospective case series undertaken in a 715-bed university-based tertiary care referral center in the United States, with a well-established medical emergency response team (MET). Adult hospitalized inpatients sustaining crisis events in the radiology suites of the University of Pittsburgh Medical Center from November 1, 2008, to October 31, 2010, were reviewed.

RESULTS: Ninety-six MET activations met our criteria. There were 92 conditions classified as C. Four conditions were characterized as A, defined as cardiopulmonary arrest. Three condition C calls progressed to cardiopulmonary arrest and were reclassified as A. A number of variables including admission diagnosis, comorbid conditions, time elapsed from admission to condition, admission source of patient, unit of origin before event, and the type of imaging study ordered were analyzed to determine any links or patterns between precursor events, the likelihood of deterioration, and the patient's subsequent clinical outcome.Forty (42%) of the conditions occurred within 24 hours of admission, and 49 (51%) occurred within the first 48 hours. Forty-six of the studies ordered were computed tomographic scans. Of those patients who sustained their condition within the first 48 hours, 41 (84%) were either outside hospital transfers or emergency department admissions. A significant proportion of acute deteriorations occurred in patients with traumatic brain injuries or strokes. Ten events (10%) were due to radiology accidents.Irrespective of etiology, the intervention of the MET allowed the study to be completed in 68 (71%) cases. Of these, 28 (41%) had their condition diagnosed by the study. Of the 10 patients who sustained a radiology accident, no patients had an adverse effect to their outcome; all were returned to their unit of origin.

CONCLUSIONS: Inpatient deterioration in the RD often occurred early in the course of the patient's hospitalization, with more than 40% taking place in the first 24 hours of admission. The MET seemed to have a positive impact on many patients, allowing a substantial percentage of studies to be completed. Interpretation of those studies often identified the etiology of the deterioration. Further study of outside hospital transfers, emergency department admissions, and intensive care unit patients who deteriorate in the RD is warranted to clarify risk factors and to identify early signs of deterioration.