Errors in imaging patients in the emergency setting

Abstract

Emergency and trauma care produces a "perfect storm" for radiological errors: uncooperative patients, inadequate histories, time-critical decisions, concurrent tasks and often junior personnel working after hours in busy emergency departments. The main cause of diagnostic errors in the emergency department is the failure to correctly interpret radiographs, and the majority of diagnoses missed on radiographs are fractures. Missed diagnoses potentially have important consequences for patients, clinicians and radiologists. Radiologists play a pivotal role in the diagnostic assessment of polytrauma patients and of patients with non-traumatic craniothoracoabdominal emergencies, and key elements to reduce errors in the emergency setting are knowledge, experience and the correct application of imaging protocols. This article aims to highlight the definition and classification of errors in radiology, the causes of errors in emergency radiology and the spectrum of diagnostic errors in radiography, ultrasonography and CT in the emergency setting.

Evaluating the effectiveness of intensive versus non‐intensive image interpretation education for radiographers: a randomised control trial study protocol

“…Errors in the interpretation of radiographs in the emergency department have important consequences for patients and clinicians. 5 Failure to correctly identify abnormalities on radiographs in a timely manner may result in delayed or inappropriate treatment leading to suboptimal outcomes for patients and potential medicolegal claims against clinicians. 6 Radiographer commenting has been proposed as a mechanism to reduce diagnostic errors by providing an immediate opinion on a radiograph at the time of image capture by the performing radiographer.…”

“…Findings from medical imaging investigations underpin many diagnostic and treatment decisions, particularly for people who have presented to hospital following a trauma event. Even with the rise in use of computed tomography since its development in 1972, radiographic image series remains the primary imaging modality requested for patients who may have sustained trauma …”

“…Even with the rise in use of computed tomography since its development in 1972, 3,4 radiographic image series remains the primary imaging modality requested for patients who may have sustained trauma. 5 In emergency settings, the definitive radiology report may not be available within a clinically relevant timeframe. 2 This means that treatment decisions are likely to have been implemented by the referring clinical team before the radiologist's report is available in many cases.…”

Evaluating the effectiveness of intensive versus non‐intensive image interpretation education for radiographers: a randomised controlled trial

“…Failure to identify fractures is the most common diagnostic error in emergency departments. 1,2 Radiographer commenting or Preliminary Image Evaluation (PIE) 3 has been suggested as a potential mechanism for reducing these errors. A PIE is a brief written description provided by the performing radiographer, which describes findings of a radiographic examination at the time of image acquisition.…”

Radiology double reads

“…Diagnostic errors in radiology reports can result in patient harm, lead to unnecessary additional testing or interventions, or otherwise diminish the quality of care delivery 1 2. In this issue, Lauritzen et al retrospectively evaluated the impact of a quality assurance process using double reads on changes made to abdominal CT reports requested by referring surgeons 3.…”