RADIOGRAPHIC INTERPRETATION IN THE EMERGENCY DEPARTMENT

This study examined the concordance of radiographic readings between e mergency department (ED) attending physicians and radiologists in a co mmunity teaching hospital. In addition, the incidents of misinterpreta tions leading to an alteration in patient care were also reviewed. All radiographs obtained from January through October 1993 were initially interpreted by ED attending physicians with subsequent final review b y attending radiology staff. Misread radiographs were placed into one of three categories. The groupings included overread radiographs with no change in treatment, underread radiographs with no change in treatm ent, and radiograph misinterpretations with a change in treatment. Of 15,585 radiographs obtained during the study period, there were 120 mi sreads; 12,099 (77.6%) of the 15,585 radiographs had an initial emerge ncy physician interpretation. Radiographic misinterpretations included 7 (5.78%) overreads, 57 (47.1%) underreads, and 57 (47.51%) misreads requiring follow up (MR-FU). The five most frequently misread radiogra phs were: abdominal, 12/247 (4.4%); rib, 3/99 (3.0%); foot, 13/621 (2. 1%); hip, 3/152 (1.9%); and ankle 11/758 (1.4%). The most frequently o btained radiographs included: chest, 7,012 (0.33% MR-FU); cervical spi ne, 1,112 (0.18% MR-FU); ankle, 758 (0.66% MR-FU); knee, 633 (0.32% MR -FU); and foot, 621 (0.97% MR-FU). In this study, 99.0% of all emergen cy department radiographs were read correctly on initial review by ED attending physicians. Of all misread radiographs, less than half (46%) were deemed clinically significant and required a follow up intervent ion. Copyright (C) 1996 by W.B. Saunders Company.