Etiology and disposition associated with radiology discrepancies on emergency department patients

Gergenti, Liza; Olympia, Robert P.

doi:10.1016/j.ajem.2019.02.027

Cited by 14 publications

(8 citation statements)

References 7 publications

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“…2 Department of Emergency Medicine, Rijnstate, Arnhem, The Netherlands. 3 Department of Surgery, Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands. 4 Department of Emergency Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.…”

Section: Authors' Information (Optional)mentioning

confidence: 99%

“…Therefore, radiographs are initially interpreted by ED treating physicians, and clinical practice is dependent on these interpretations. A recent study by Gergenti et al, performed during 'out of office' hours, showed that missed fractures are among the most common radiology error, even for radiology residents and staff [3]. In the literature, figures can be found regarding radiologic errors among radiologists and ED treating physicians (1.4-2.4%), Department of Surgery interns (3.1%), orthopaedists (2.5%) and radiology residents (1.8%) [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Radiologic discrepancies in diagnosis of fractures in a Dutch teaching emergency department: a retrospective analysis

Mattijssen-Horstink

Langeraar

Mauritz

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background Missed fractures in the emergency department (ED) are common and may lead to patient morbidity. Aim To determine the rate and nature of radiographic discrepancies between ED treating physicians, radiologists and trauma/orthopaedic surgeons and the clinical consequences of delayed diagnosis. A secondary outcome measurement is the timeframe in which most fractures were missed. Methods A single-centre retrospective analysis of all missed fractures in a general teaching hospital from 2012 to 2017 was performed. Data regarding missed fractures were provided by the hospital’s complication list and related database. Additional data were retrieved from the electronic medical records as required for the study. Results A total of 25,957 fractures were treated at our ED. Initially, 289 fractures were missed by ED treating physicians (1.1%). The most frequently missed fractures were the elbow (28.6%) and wrist (20.8%) in children, the foot (17.2%) in adults and the pelvis and hip (37.3%) in elderly patients. Patients required surgery in 9.3% of missed fractures, received immobilization by a cast or brace in 45.7%, had no treatment alterations during the first week in 38.1%. Follow-up data were lacking for 6.9% of cases. 49% of all missed fractures took place between 4 PM and 9 PM. There is a discrepancy in percentages of correctly diagnosed fractures and missed fractures between 5 PM and 3 AM. Conclusion Adequate training of ED treating physicians in radiographic interpretation is essential in order to increase diagnostic accuracy. A daily multidisciplinary radiology meeting is very effective in detecting missed fractures.

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Section: Authors' Information (Optional)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiologic discrepancies in diagnosis of fractures in a Dutch teaching emergency department: a retrospective analysis

Mattijssen-Horstink

Langeraar

Mauritz

et al. 2020

Scand J Trauma Resusc Emerg Med

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“…In our analysis, the timestamps in the timeline analysis reflected the times at which the written radiology reports (at least preliminary reports before sign-off) were delivered. Published studies have reported minimal discrepancies between preliminary and final reports [ 35 36 37 38 ]. Furthermore, in daily practice, preliminary written reports of critical findings are frequently verbally confirmed before they are signed by ED staff radiologists.…”

Section: Discussionmentioning

confidence: 99%

Clinical Impact of a Quality Improvement Program Including Dedicated Emergency Radiology Personnel on Emergency Surgical Management: A Propensity Score-Matching Study

Hong

Lee

et al. 2022

Korean J Radiol

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Objective To investigate the clinical impact of a quality improvement program including dedicated emergency radiology personnel (QIP-DERP) on the management of emergency surgical patients in the emergency department (ED). Materials and Methods This retrospective study identified all adult patients (n = 3667) who underwent preoperative body CT, for which written radiology reports were generated, and who subsequently underwent non-elective surgery between 2007 and 2018 in the ED of a single urban academic tertiary medical institution. The study cohort was divided into periods before and after the initiation of QIP-DERP. We matched the control group patients (i.e., before QIP-DERP) to the QIP-DERP group patients using propensity score (PS), with a 1:2 matching ratio for the main analysis and a 1:1 ratio for sub-analyses separately for daytime (8:00 AM to 5:00 PM on weekdays) and after-hours. The primary outcome was timing of emergency surgery (TES), which was defined as the time from ED arrival to surgical intervention. The secondary outcomes included ED length of stay (LOS) and intensive care unit (ICU) admission rate. Results According to the PS-matched analysis, compared with the control group, QIP-DERP significantly decreased the median TES from 16.7 hours (interquartile range, 9.4–27.5 hours) to 11.6 hours (6.6–21.9 hours) ( p < 0.001) and the ICU admission rate from 33.3% (205/616) to 23.9% (295/1232) ( p < 0.001). During after-hours, the QIP-DERP significantly reduced median TES from 19.9 hours (12.5–30.1 hours) to 9.6 hours (5.7–19.1 hours) ( p < 0.001), median ED LOS from 9.1 hours (5.6–16.5 hours) to 6.7 hours (4.9–11.3 hours) ( p < 0.001), and ICU admission rate from 35.5% (108/304) to 22.0% (67/304) ( p < 0.001). Conclusion QIP-DERP implementation improved the quality of emergency surgical management in the ED by reducing TES, ED LOS, and ICU admission rate, particularly during after-hours.

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“…In a retrospective study analyzing the emergency department at Penn State Hershey Medical Center, it was found that, like our study, most radiographic misreads were missed fractures. 9 Another study conducted at George Washington University that analyzed scans from the ED also found that the most common radiographic misinterpretation between emergency physicians and radiologists was fractures. 10 Even so, misinterpretations only accounted for 3% of the total rereads.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Reread Protocols to Identify Clinically Relevant Errors in Initial Trauma Evaluations

Morgan

Brown

Vernon

et al. 2021

The American Surgeon

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Introduction Diagnostic radiology interpretive errors in trauma patients can lead to missed diagnoses, compromising patient care. Due to this, our level II trauma center implemented a reread protocol of all radiographic imaging within 24 hours on our highest trauma activation level (Code T). We sought to determine the efficacy of this reread protocol in identifying missed diagnoses in Code T patients. We hypothesized that a few, but clinically relevant errors, would be identified upon reread. Methods All radiographic study findings (initial read and reread) performed for Code T admissions from July 2015 to May 2016 were queried. The reviewed radiological imaging was given one of four designations: agree with interpretation, minor (non-life threatening) nonclinically relevant error(s)—addendum/correction required or clinically relevant error(s) (major [life threatening] and minor)—addendum/correction required, and trauma surgeon notified. The results were compiled, and the number of each type of error was calculated. Results Of the 752 radiological imaging studies reviewed on the 121 Code T patients during this period, 3 (0.40%) contained minor clinically relevant errors, 11 (1.46%) contained errors that were not clinically relevant, and 738 (98.1%) agreed with the original interpretation. The three clinically relevant errors included a right mandibular fracture found on X-ray and a temporal bone fracture that crossed the clivus and bilateral rib fractures found on computerized tomography. Discussion Clinically relevant errors, although minimal, were discovered during rereads for Code T patients. Although the clinical errors were significant, none affected patient outcomes. We propose that the implementation of reread protocols should be based upon institution-specific practices.

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Etiology and disposition associated with radiology discrepancies on emergency department patients

Cited by 14 publications

References 7 publications

Radiologic discrepancies in diagnosis of fractures in a Dutch teaching emergency department: a retrospective analysis

Radiologic discrepancies in diagnosis of fractures in a Dutch teaching emergency department: a retrospective analysis

Clinical Impact of a Quality Improvement Program Including Dedicated Emergency Radiology Personnel on Emergency Surgical Management: A Propensity Score-Matching Study

Radiographic Reread Protocols to Identify Clinically Relevant Errors in Initial Trauma Evaluations

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