Radiograph Interpretation Discrepancies in a Community Hospital Emergency Department

Abstract

Introduction In many hospitals, off-hours emergency department (ED) radiographs are not read by a radiologist until the following morning and are instead interpreted by the emergency physician (EP) at the time of service. Studies have found conflicting results regarding the radiographic interpretation discrepancies between EPs and trained radiologists. The aim of this study was to identify the number of radiologic interpretation discrepancies between EPs and radiologists in a community ED setting. Methods Using a pre-existing logbook of radiologic discrepancies as well as our institution’s picture archiving and communication system, all off-hours interpretation discrepancies between January 2012 and January 2015 were reviewed and recorded in a de-identified fashion. We recorded the type of radiograph obtained for each patient. Discrepancy grades were recorded based on a pre-existing 1–4 scale defined in the institution’s protocol logbook as Grade 1 (no further action needed); Grade 2 (call to the patient or pharmacy); Grade 3 (return to ED for further treatment, e.g., fracture not splinted); Grade 4 (return to ED for serious risk, e.g., pneumothorax, bowel obstruction). We also recorded the total number of radiographs formally interpreted by EPs during the prescribed time-frame to determine overall agreement between EPs and radiologists. Results There were 1044 discrepancies out of 16,111 EP reads, indicating 93.5% agreement. Patients averaged 48.4 ± 25.0 years of age and 53.3% were female; 25.1% were over-calls by EPs. The majority of discrepancies were minor with 75.8% Grade 1 and 22.3% Grade 2. Only 1.7% were Grade 3, which required return to the ED for further treatment. A small number of discrepancies, 0.2%, were Grade 4. Grade 4 discrepancies accounted for two of the 16,111 total reads, equivalent to 0.01%. A slight disagreement in finding between EP and radiologist accounted for 8.3% of discrepancies. Conclusion Results suggest that plain radiographic studies can be interpreted by EPs with a very low incidence of clinically significant discrepancies when compared to the radiologist interpretation. Due to rare though significant discrepancies, radiologist interpretation should be performed when available. Further studies are needed to determine the generalizability of this study to EDs with differing volume, patient population, acuity, and physician training.

Performance of the Fresno-Quebec Rule in identifying patients with concomitant fractures not requiring a radiograph before shoulder dislocation reduction: a multicenter retrospective cohort study

“…Instead, the initial interpretation was conducted by a senior emergency physician, followed by a thorough review by a trained emergency medicine resident. However, it is worth noting that in previous studies, investigators have noted that the incidence of clinically significant discrepancies in radiographs interpreted by emergency physicians is not lower than that of those interpreted by radiologists [20,21].…”

Analysis of critical report notification from musculoskeletal radiology in a tertiary academic medical institution with a regional trauma center

“…Missed fractures represent up to 80% of diagnostic errors in the ED [ 10 ], and it frequently lead to legal problems in medicine [ 11 ]. Given the radiology workforce shortage and emergent clinical situations, physicians in the ED should often make management decisions before radiologic reports become available, especially considering plain radiographs [ 12 , 13 ]. In our study, the cervical spine was the most common location of missed fractures, showing consistency with various studies that have reported that plain radiography may lead to miss more than 50% of cervical spine fractures for reasons including inadequate cervical spine series (e.g., lateral view only, non-visualization of C7-T1) and misreading of plain radiographies with or without adequate standard series [ 10 , 14 , 15 ].…”

Patient recalls associated with resident-to-attending radiology report discrepancies: predictive factors for risky discrepancies

“…The RRDs were categorized on a scale from 1‒4 according to the patients’ disposition and outcomes [ 2 , 16 ]. Category 1 was a minor discrepancy with no additional immediate action needed.…”

“…There have been numerous studies on resident-to-attending radiology report discrepancies (RRDs). Most studies have focused on discrepancy rates between preliminary and finalized radiology reports and have underscored the diagnostic imaging modalities in which RRDs are frequently found [ 2 – 6 ]. Several studies have emphasized the importance of resident training level and attending radiologists reading after hours [ 3 , 7 ].…”