Alterations of preliminary readings on radiographic examinations minimallyaffect outcomes of trauma patients discharged from the emergency department

Background: We hypothesized that trauma patients could be discharged safely from the emergency department (ED) before the availability of official rea dings for their radiologic examinations. We also sought to determine whethe r trauma patients were more prone to alterations of preliminary interpretat ions than other ED patients. Methods: Alterations of preliminary readings (PR) for patients discharged f rom the ED were reviewed, If the official readings conflicted with the PR u sed for the patient's disposition, attempts were made to contact the patien t and provide the appropriate follow-up. Data recorded included the type of radiographic examination, the presence of a missed injury, and the follow- up. By using institutional data, the incidence of inaccurate PR were compar ed for trauma patients and other ED patients (X-2 test, Fisher exact test, p < 0.05). Results: Between January of 1998 and December of 1998, 102 of 38,260 discha rged ED patients had official readings differing from PR. Forty-three of th e changed readings involved 42 of the 1,073 discharged trauma patients, who mere more likely to harbor inaccurate PR (<0.0001) than other discharged E D patients. Twenty-eight altered readings involved plain films and 15 invol ved computed tomographic scans. The most common altered readings involved c omputed tomographic scans of the head and face (n = 13). Twelve missed inju ries were detected, most commonly related to a missed injury of the extremi ty (7 cases). Nine other cases involved the detection of incidental patholo gic conditions. Eight patients required repeat ED visits for clinical and r adiographic evaluation, and one patient required subsequent hospital admiss ion, Conclusion: Discharged trauma patients are more likely to harbor alteration s of preliminary interpretations than other ED patients. Although the offic ial readings for these trauma patients will occasionally reveal previously undetected pathologic conditions, the majority of such cases can be managed with outpatient follow-up.