Who Should Be Reading Chest Radiographs in the Pediatric Emergency Department?

Abstract

Although the clinically significant discordant rate was relatively low, daily chest radiograph reassessment by pediatric radiologists in a joint meeting with pediatricians has an added value for patient safety, quality assurance, and mutual training.

Deep-Learning-Based Diagnosis of Bedside Chest X-ray in Intensive Care and Emergency Medicine

“…Although CXRs are an important and cost-and time-effective diagnostic tool for the management of critically ill patients in the ED and ICU, it was previously shown that interrater reliability for CXRs is poor and that experienced readers are needed to ensure a reliable assessment. 6,10,28 Gatt et al 6 reported a sensitivity of 0.2 to 0.64 for findings such as air-space opacification, pleural effusion, or congestion for nonradiologist physicians in the ED. Similar results were found by Soudack et al, 28 who observed that reassessment of radiographs through an expert radiologist resulted in a change of diagnosis in nearly one-third of the cases.…”

“…6,10,28 Gatt et al 6 reported a sensitivity of 0.2 to 0.64 for findings such as air-space opacification, pleural effusion, or congestion for nonradiologist physicians in the ED. Similar results were found by Soudack et al, 28 who observed that reassessment of radiographs through an expert radiologist resulted in a change of diagnosis in nearly one-third of the cases. It should, however, be emphasized that in both aforementioned studies, only 1 radiologist determined the final diagnosis.…”

Determining the clinical significance of errors in pediatric radiograph interpretation between emergency physicians and radiologists

“…Reported discrepancy rates between EP and radiologist readings have ranged between 1% and 28%. [1][2][3][4][5][6][7][8][9][10][11][12][13] However, clinically significant discrepancies that lead to a change in patient management are relatively uncommon; reported rates ranged from 0% to 9%, according to the studies cited previously. Studies in adult EDs have generally reported lower imaging discrepancy rates than those found in pediatric EDs, ranging from 0.8% to 3.7%.…”

A Performance-Based Competency Assessment of Pediatric Chest Radiograph Interpretation Among Practicing Physicians

“…4,11–13 Although systems are often in place for the correction of errors made at the bedside, the final report by a radiologist may not be available in a timely manner to influence immediate decision-making, and in resource limited settings, there may be no radiologist over-read of the pCXR at all. 1,9,14–16…”