Performance of a multistate teleradiology service in emergency pediatric and adolescent neuroimaging: a two-year retrospective study

INTRODUCTION: Pediatric neuroradiology expertise is limited in many healthcare facilities, especially in the emergency setting. Teleradiology offers a promising solution by providing remote access to subspecialty interpretation. Our study aimed to evaluate the performance and outcomes of a teleradiology service for emergency pediatric neuroradiology across multiple U.S. states. METHODS: We conducted a retrospective analysis of pediatric head/brain and spine computed tomography (CT) and magnetic resonance (MR) studies transmitted from 107 hospitals across 17 U.S. states to a teleradiology service from January 2023 to December 2024. Primary outcomes included turnaround time (TAT), diagnostic yield, and demographic patterns. Statistical analyses included descriptive statistics, confidence intervals, and comparative testing with appropriate effect size calculations. RESULTS: A total of 9,985 scans from 7,958 patients (57.3% male, mean age 11.08 years) were analyzed. CT studies formed 96.8% of cases with mean TAT of 37.5 min (95% CI: 37.1–37.9), while MR studies averaged 61.2 min (95% CI: 57.6–64.8). Overall positive finding rate was 13.4% (95% CI: 12.8–14.1%). Hemorrhage was the most common finding (5.68%), followed by skull fracture (3.17%). Trauma-related findings represented 66.0% of positive cases. Significant differences were observed between CT and MR regarding gender distribution (57.8% vs. 49.4% male, P-value = 0.003) and between head versus spine imaging regarding patient age (10.41 vs. 13.43 years, P-value < 0.001). CONCLUSIONS: Teleradiology demonstrated good performance in emergency pediatric neuroradiology with rapid turnaround times and optimal diagnostic yield. Teleradiology successfully bridges expertise gaps across different geographic regions while maintaining high-quality interpretation standards for time-sensitive pediatric neurologic emergencies. CLINICAL TRIAL REGISTRATION NUMBER: Not applicable.