EMERGENCY-MEDICINE RESIDENT INTERPRETATION OF PEDIATRIC RADIOGRAPHS

Objective: To examine the concordance of pediatric radiograph interpre tation between emergency medicine residents (EMRs) and radiologists. M ethods: A prospective, observational study was performed in a universi ty pediatric ED with an annual census of 60,000 visits, Radiographs or dered by EMRs from December 1993 through October 1994 were initially i nterpreted solely by the EMR, with subsequent unmasked final review by attending radiology staff. Misinterpreted radiographs were placed int o 3 categories. The groupings included overreads, underreads with no c hange in treatment, and underreads that required a change in treatment . Results: A total of 415 radiographs were interpreted by PGY1-3 resid ents. Overall concordance was found for 371 radiographs (89.4%). There were 44 misinterpretations (10.6%), with 24 (5.78%) overreads, 13 (3. 13%) underreads, and 7 (1.69%) underreads that required follow-up inte rventions, Misinterpretations were similar for the different levels of training: [GRAPHICS] The 5 most frequently ordered radiographs were c hest (28%), ankle (7%), foot (6%), wrist (5%), and hand (5%). The most frequently misinterpreted radiographs were sinus, foot, shoulder, fac ial, and hand. Conclusion: 89.4% of all the radiographs interpreted by PGY1-3 residents were read correctly. Only 1.69% of the misinterprete d radiographs led to a change in management. Level of training did not significantly correlate with radiograph misinterpretation rates.