Radiologists' review of radiographs interpreted confidently by emergency physicians infrequently leads to changes in patient management.

STUDY OBJECTIVE To determine whether radiologists' review of radiographs is unwarranted when emergency physicians are confident in their interpretations. METHODS This was a prospective, descriptive study. Treating emergency physicians at a high-volume, urban teaching hospital and a moderate-volume nonteaching hospital indicated their confidence or lack of confidence in their plain-film radiographic study interpretations. All radiographs were then reviewed by radiologists according to the preexisting practice of each hospital. A total of 16,410 emergency department radiographic studies were included, comprising consecutive patients at each hospital. Charts of all discordant readings in the confident group were reviewed and judged clinically significant if treatment was altered. Charges for radiologic review of the confident ED interpretations were calculated. RESULTS The ED physicians were confident in 9,599 sets of radiographs out of a total of 16,410 (58%). Discordant interpretation rates for the "confident" and "not confident" groups were 1.2% and 3.1%, respectively (difference, 1.9%; 95% confidence interval [CI] of the difference, 1.44% to 2.36%). Review of the 118 discordant interpretations in the confident group demonstrated that 11 were significant. Few management changes were made as a result of radiologists' review of these radiographs. Total radiology review charges for the confident group were $215,338. Therefore the average radiology charge for each significant discordant interpretation was $19,576. CONCLUSIONS Of 9,599 sets of radiographs interpreted confidently by the emergency physicians in this study, there were 11 clinically significant discordant interpretations (0.1%). The standard practice of radiologists' review of all ED radiographs may not be justifiable.

[1]  B. Mucci.  The selective reporting of X-ray films from the Accident and Emergency Department. , 1983, Injury.

[2]  J. Lawson,et al.  Should all casualty radiographs be reviewed? , 1985, British medical journal.

[3]  R Eban,et al.  Reducing errors in the accident department: a simple method using radiographers. , 1985, British medical journal.

[4]  Correlation Of Emergency Department Radiographs: Results Of A Quality Assurance Review In An Urban Community Hospital Setting , 1993, The Journal of the American Board of Family Medicine.

[5]  R. M. Smith,et al.  Value of radiograph audit in an accident service department. , 1992, Injury.

[6]  G Podgorny,et al.  An emergency department radiology audit procedure. , 1977, JACEP.

[7]  McLain Pl,et al.  The quality of emergency room radiograph interpretations. , 1985 .

[8]  R G Swensson,et al.  Improving performance by multiple interpretations of chest radiographs: effectiveness and cost. , 1978, Radiology.

[9]  J. Aldag,et al.  Accuracy of interpretations of emergency department radiographs: effect of confidence levels. , 1989, Annals of emergency medicine.

[10]  D Ozonoff,et al.  Disagreements in chest roentgen interpretation. , 1975, Chest.

[11]  N. Powe.  Economic and cost-effectiveness investigations of radiologic practices. , 1994, Radiology.

[12]  C. Galasko,et al.  Value of Re-examining X-ray Films of Outpatients Attending Accident Services , 1971, British medical journal.

[13]  J. Masel,et al.  Accuracy of radiological diagnosis in the Casualty Department of a Children's Hospital , 1984, Australian paediatric journal.

[14]  J. Marx,et al.  Accuracy of emergency radiograph interpretation by emergency physicians. , 1984, The Journal of emergency medicine.

[15]  G. Fleisher,et al.  Interpretation of pediatric x-ray films by emergency department pediatricians. , 1983, Annals of emergency medicine.

[16]  J. Harper,et al.  An assessment of the clinical effects of reporting accident and emergency radiographs. , 1980, The British journal of radiology.

[17]  D. Seaberg,et al.  Radiographic interpretation in the emergency department. , 1996, The American journal of emergency medicine.

[18]  Garland Lh.  Studies on the accuracy of diagnostic procedures. , 1959 .

[19]  L. Garland.  On the scientific evaluation of diagnostic procedures. , 1949, Radiology.

[20]  M. Gratton,et al.  Clinically significant radiograph misinterpretations at an emergency medicine residency program. , 1990, Annals of emergency medicine.

[21]  R. O’Connor,et al.  The rate of clinically significant plain radiograph misinterpretation by faculty in an emergency medicine residency program. , 1996, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.