SUMMARY Even experienced radiologists often differ among themselves about the interpretation of emergency room radiographs, and have a significant error rate. Routine radiological review of interpretation by emergency room physicians should detect most clinically relevant errors in timely fashion.
Overall, emergency room physicians and radiologists disagree in the interpretation of plain radiographs about ten percent of the time 1, 2; in about a fifth of these cases the error requires a change of treatment.
Emergency room physicians, both in a high volume teaching hospital and in a moderate volume nonteaching hospital, were confident in their own interpretation of radiographs 58% of the time. Clinically significant errors were present in only 0.1% in these cases 3.
Practice PointAs in other areas of medicine, not knowing is a lesser problem than unawareness of ignorance |
Usual hospital practice 4 requires that radiologists review radiographs within 12-24 hours, and this review may result in a change in treatment, with or without patient recall to the emergency room 5. Many hospitals encourage clinicians to document, on the envelope containing the xray films, their emergency interpretations of radiographs, so that reviewing radiologists know when errors have occurred.
Even experienced radiologists often differ among themselves about the interpretation of emergency room radiographs, and have a significant error rate. When independently reporting significant abnormalities on plain chest, abdominal and skeletal radiographs ordered in the emergency department, 3 experienced radiologists differed in 8-19% of cases 6. Their individual error rates were in the 3-6% range.
Routine radiological review of interpretation by emergency room physicians should detect most clinically relevant errors in timely fashion. Missed fractures and missed foreign-bodies are among the commonest causes of medical malpractice action against emergency room physicians.
The checking system fails at different stages:
1. For foreign-bodies, though rarely for fractures, the expert radiological review may be too late to prevent material injury.
2. Both emergency room physician and radiologist may miss a significant abnormality.
3. When the radiologist identifies an abnormality missed by the clinician, the report may not reach the emergency department (or general practitioner), or it may not be appropriately acted on.
Practice PointErroneous interpretation of emergency radiographs is often less important clinically than failure to communicate the error |
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