Emergency physician error rates for interpretation of plain radiographs and utilization of radiologist consultation

Abstract

Emergency physicians’ errors of interpretation of plain radiographs and these physicians’ utilization of radiologist consultation services were studied. During daytime hours over a 3-month period, 953 radiograph packets on emergency department patients were reviewed in the radiology department after initial interpretation by an emergency department physician. Consultation requests and clinically significant discordances between radiology and emergency department interpretations were tabulated. Discordances were categorized by the type of examination and the type of error. The time between each packet’s arrival in the radiology department and issuance of a report was recorded. After completion of data collection, all of the discrepant cases were reviewed by a staff emergency room physician and a staff radiologist to establish the proper interpretation and the source of the discordance.

Radiologist consultation was requested for 106 (11.1%) of the packets. Of the 847 packets for which the emergency room physician did not request radiologist consultation, radiologist and emergency physician interpretations agreed in 776 (91.6%) and were discordant in 71 (8.4%) of the packets. Of 65 cases available for discrepancy review, the reviewers agreed with the radiologist’s interpretation in 60 (92%) of the cases and disagreed in 5 (8%) of the cases. Ten (17%) of the discordances were the result of overcalls, 47 (78%) were the result of overlooked findings, and 3 (5%) were the result of misinterpretations of findings. Sixty-eight percent of the discordances in interpretation were made to chest studies, 15% to abdominal studies, and 17% to musculoskeletal studies.

Emergency physicians at the study institution requested consultations from a radiologist in 11.1% of cases. They made potentially important errors on independent interpretation of plain radiographs in 60 of 847 (7.1%) of cases for which consultation was not sought. Radiologists misinterpreted radiographs in 5 cases. These data suggest that radiologists play an important role in emergency health care delivery and should continue to routinely interpret all emergency department radiographs.