THE RATE OF CLINICALLY SIGNIFICANT PLAIN RADIOGRAPH MISINTERPRETATIONBY FACULTY IN AN EMERGENCY-MEDICINE RESIDENCY PROGRAM

Objective: To estimate the rate of clinically significant discrepancie s between radiograph interpretations by attending radiologists and eme rgency medicine (EM) faculty in 2 academic EDs, using a unique scoring system. Methods: A retrospective comparison of radiographic agreement between EM and radiology faculty members was performed, All plain fil ms initially interpreted by EM faculty or by EM residents with immedia te reinterpretation by EM faculty were subsequently reviewed by attend ing radiologists. All discrepancies between these readings were report ed to the ED on the following day for review by an EM faculty member ( usually different from the initial EM faculty reader) who determined t he need for treatment or follow-up changes, A secondary chart review b y a quality assurance faculty member determined whether radiographic f indings not noted on the x-ray log were present on the ED record. All discrepancies from February to June 1994 were reviewed. A severity sco re was assigned based on the following criteria, Q-0: There was no cha nge in treatment or follow-up; or the initial interpretation by EM fac ulty was validated by repeat or additional views. Q-1: Discrepancy is minor. Q-2: Discrepancy is significant, with potential for injury or b ad outcome, Q-3: Discrepancy is significant, with actual injury or bad outcome. Results: Of 14,046 radiographic studies eligible for enrollm ent, there were 134 discrepancies (0.95%). Only 28 cases (0.2%) were f ound to be clinically significant, Of these, 25 were scored Q-1, 3 wer e scored Q-2, and 0 were scored Q-3, These clinically significant disc repancy rates were highest for the finger, skull, elbow, hand, and lum bar spine. Conclusion: Emergency medicine faculty provide highly accur ate rates of plain radiograph interpretation, particularly when adjust ed for clinical significance and actual impact on patient care.