La. Nitowski et al., THE RATE OF CLINICALLY SIGNIFICANT PLAIN RADIOGRAPH MISINTERPRETATIONBY FACULTY IN AN EMERGENCY-MEDICINE RESIDENCY PROGRAM, Academic emergency medicine, 3(8), 1996, pp. 782-789
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.