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1982. Bubbles in the Belly: How Well do Radiology Residents Recognize Pneumatosis in Pediatric Patients on Plain Film?
Authors * Denotes Presenting Author
  1. Priya Sharma *; University of Florida
  2. Dhanashree Rajderkar; University of Florida
  3. Christopher Sistrom; University of Florida
  4. Roberta Slater; University of Florida
  5. Anthony Mancuso; University of Florida
Objective:
Pneumatosis intestinalis is a radiographic finding which refers to the presence of gas within the walls of the small or large bowel. This sign is diagnostic in the setting of premature infants with suspected necrotizing enterocolitis. Necrotizing enterocolitis (NEC) is a common gastrointestinal emergency in premature neonates and infants with congenital cardiac anomalies. Intramural gas in this setting is felt to be a result of insult to the mucosal integrity from inflammation and ischemic necrosis resulting in the air and bacteria gaining access to the submucosa. Early recognition of these findings is critical as proper management including bowel rest, decompression of the bowel loops and antibiotic therapy to have significant effects on morbidity and mortality in these infants. Mortality is significantly higher in infants who have bowel perforation secondary to NEC. Hence, earlier detection of NEC on x-ray is vital to improve the overall management in these infants. To date, plain radiography is the modality of choice in diagnosing pneumatosis.The identification of pnematosis intestinalis concerning for necrotizing enterocolitis by the “on-call” resident is critical in the care of the preterm infant. The resident’s ability to identify pneumatosis on an emergent overnight film has not previously been studied.

Materials and Methods:
The Emergent/Critical Care Imaging SIMulation (WIDI SIM) is a strategically designed computer aided simulation of an emergency imaging experience that has been rigorously testing and proven to be a reliable means for assessing resident preparedness to competently and independently cover radiology call. The residents are provided with a total of 65 cases of varying difficulty, including normal studies performed on both adult and pediatric population. One case included requires the resident to accurately identify pneumatosis on a plain radiograph of the abdomen in a neonate. The residents respond using free text which is then scored by faculty members utilizing a robust grading rubric. Missed cases are then categorized by observation error and/or interpretative errors. Score of 3 or less is considered as a ‘missed case’ or missed findings with a potential to harm the patient.

Results:
A total of 241 residents from 46 programs across the country were given a case of pneumatosis using the WIDI simulation web-based testing platform. The majority of residents being tested were from the first or second years of training. A smaller sample of residents were in the third or fourth years of training. On average nearly 60% of residents were able to correctly identify pneumatosis intestinalis on plain film. Although the sample sizes in the upper levels residents were smaller, those with greater number years of training performed better with 80% of 4th year residents correctly calling this case.

Conclusion:
Radiology residents are able to assert the concern for necrotizing enterocolitis fairly well when taking overnight call. Autonomous overnight residents are able to provide high level standard of care for the interpretation of neonatal abdominal radiographs.