A comparative study of structured and free text CT reporting for patients with traumatic brain injury at Mulago Hospital

Abstract

Background: Radiology reports are essential for communicating imaging findings to the referring clinicians and facilitating clinical decision-making. However, the traditional free-text format of radiology reports (FTR) can be inconsistent, incomplete, and unclear, leading to potential errors and misinterpretations. Structured reporting (SR) is a method of creating radiology reports using predefined templates or categories to improve radiology reports' quality, clarity, and consistency. The objective of this study was to compare SR with FTR in reporting CT scans of patients with traumatic brain injury at MNRH. Methods: This cross-sectional study was conducted at Mulago National Referral Hospital to evaluate the impact of structured reporting versus free-text reporting in the radiological assessment of traumatic brain injury (TBI). The study included a sample of patients already diagnosed with TBI. Radiology reports were generated using both SR templates and FTR methods. Completeness was scored based on major (2 points) and minor (1 point) criteria. Interobserver agreement was assessed using Cohen’s Kappa statistic. Statistical analyses were performed to compare the effectiveness of SR and FTR, with significance set at p<0.05. Results: This study evaluated the efficacy and interobserver agreement of Structured Reporting (SR) and Free Text Reporting (FTR) against a gold standard in radiological assessments across multiple criteria. SR demonstrated improved completeness over FTR. The overall average SR score (18.5) was higher than that of FTR (14.0) across all participants, indicating more exhaustive reporting in SR. Interobserver agreement among participants was also notably higher with SR in criteria such as Brainstem Major, Cerebral Minor and CSF Spaces Minor with kappa values ranging from 0.45 to 1.0. Conclusion: This study demonstrates that structured reporting (SR) significantly improves the completeness of radiology reports for traumatic brain injury (TBI) at Mulago National Referral Hospital. The Radiology department at MNRH and the Ministry of Health should consider implementing SR widely, supported by targeted training, IT infrastructure upgrades, and continuous research, to improve radiology services and patient outcomes across Uganda.