Accuracy of radiographic readings in the emergency department

Petinaux, Bruno; Bhat, Rahul; Boniface, Keith; Aristizabal, J.

doi:10.1016/j.ajem.2009.07.011

Cited by 72 publications

(52 citation statements)

References 33 publications

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“…However, published evidence suggests that the findings of this study would be similar were the service to have been delivered by radiologists due to similar reporting standards [23,24]. Greater discordance is known to exist between radiology and clinicians in the interpretafion of visceral radiographs [6,13,35]. Cor\sequenfly, the extension of an immediate reporting service to include these examinafions may further reduce interprefive errors and improve ED service quality, although further research is required to explore the impact of such a pathway.…”

Section: Discussionmentioning

confidence: 76%

“…Previous studies have raised concerns regarding the accuracy of interpretation achieved by junior medical staff and ENPs, with reported interpretive discrepancy rates between ED and radiology ranging from 1.2% to 7.8% [12][13][14][15][16][17]. Undiagnosed injuries, or a delay in diagnosis, can predispose patients to longterm morbidity and have the potenfial for litigation [15,17,18].…”

mentioning

confidence: 94%

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The impact of immediate reporting on interpretive discrepancies and patient referral pathways within the emergency department: a randomised controlled trial

Hardy

Snaith²,

Scally³

2013

BJR

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Section: Discussionmentioning

confidence: 76%

mentioning

confidence: 94%

The impact of immediate reporting on interpretive discrepancies and patient referral pathways within the emergency department: a randomised controlled trial

Hardy

Snaith²,

Scally³

2013

BJR

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“…Similarly, some practices allow non-radiologists to interpret imaging studies. Multiple studies have reported a broad range of discrepancy rates between radiologists and non-radiologists, however, of the noted discrepancies, many fell into categories our review found to be high-litigation diagnoses such as missed fractures and pulmonary nodules or malignancies [3][4][5][6]. It is our goal to improve prompt identification of these important findings by recommending the adoption of comparable review processes whereby a radiologist "over-reads" imaging studies initially interpreted by non-radiologists.…”

Section: Radiology Interpretation Errorsmentioning

confidence: 99%

The role of radiology in diagnostic error: a medical malpractice claims review

Siegal¹,

Stratchko

DeRoo

2017

Diagnosis

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Abstract:Just as radiologic studies allow us to see past the surface to the vulnerable and broken parts of the human body, medical malpractice claims help us see past the surface of medical errors to the deeper vulnerabilities and potentially broken aspects of our healthcare delivery system. And just as the insights we gain through radiologic studies provide focus for a treatment plan for healing, so too can the analysis of malpractice claims provide insights to improve the delivery of safe patient care. We review 1325 coded claims where Radiology was the primary service provider to better understand the problems leading to patient harm, and the opportunities most likely to improve diagnostic care in the future.Keywords: diagnostic error; malpractice claims; radiology. OverviewThe medical diagnostic process involves a complex network of interactions between the patient and the healthcare system. This process is also dynamic, requiring one or more cycles of patient interaction, informationgathering and data synthesis in order to understand the intricacies of each patient's clinical picture and pathology. Failures can occur at any point along the continuum of care, each of which has the potential to result in inaccurate or delayed diagnosis as well as inappropriate treatment. While radiology typically does not play the initial role in the diagnostic process, misinterpretation or delayed communication of imaging findings can certainly lead to a breakdown in the progression towards clarity of diagnosis and appropriate patient care.Analysis of the CRICO Comparative Benchmarking System (CBS) determined that 29,777 medical malpractice cases, asserted between 2010 and 2014, had completed an in-depth review by CRICO's team of Clinical Taxonomy Specialists. Reviewing the medical and legal files of each of these cases, an experienced clinician used CRICO's propriety coding taxonomy to capture and code multiple case attributes including allegation, patient demographics, diagnosis and injury, location, tests and services, and the key causation factors contributing to the clinical error or failure.Of the 29,777 medical malpractice cases available for analysis, 1325 cases named Radiology as the Primary Responsible Service -42% resulted in high severity (based on National Associationn of Insurance Commissioners clinical injury severity score) clinical injuries including 235 deaths (Figure 1). Diagnostic related events represent nearly 60% of the 1325 radiology claims, followed by procedural issues (22%), equipment issues, (7%) and falls and safety issues (6%). In those cases involving diagnostic radiology, nearly 50% of the cases involved one of these four modalities: computed tomography (CT) scans (20%), mammography (11%), magnetic resonance imaging (MRI) (10%) and diagnostic ultrasound (4%). Cases occurred in a variety of settings though ambulatory cases were the most common at 63% followed by inpatient (26%) and emergency department (11%).In many cases, Radiology is not the only clinical service identified as "responsible" o...

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“…Early studies reported low rates of accuracy in initial interpretation by emergency department clinicians 10 11. More recently, publications have reported much improved interobserver reliability 6 7 12. One study published levels of disagreement that were so low (1.2%) the authors concluded only selective radiographs should be reported by radiologists 12…”

Section: Introductionmentioning

confidence: 99%

Do emergency physicians and radiologists reliably interpret pelvic radiographs obtained as part of a trauma series?

et al. 2012

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The ability to interpret trauma series pelvic radiographs is comparable between emergency physicians and radiologists. If this were also true of trauma chest radiographs, then the most valuable use of the radiologist may not be the resuscitation room but in rapid reporting of more complex imaging techniques. However, plain radiography is insensitive for pelvic fracture detection compared with CT, even in expert hands.

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Accuracy of radiographic readings in the emergency department

Cited by 72 publications

References 33 publications

The impact of immediate reporting on interpretive discrepancies and patient referral pathways within the emergency department: a randomised controlled trial

The impact of immediate reporting on interpretive discrepancies and patient referral pathways within the emergency department: a randomised controlled trial

The role of radiology in diagnostic error: a medical malpractice claims review

Do emergency physicians and radiologists reliably interpret pelvic radiographs obtained as part of a trauma series?

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