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Research ArticleAdult Brain

Diagnostic Errors in Cerebrovascular Pathology: Retrospective Analysis of a Neuroradiology Database at a Large Tertiary Academic Medical Center

G. Biddle, R. Assadsangabi, K. Broadhead, L. Hacein-Bey and V. Ivanovic
American Journal of Neuroradiology September 2022, 43 (9) 1271-1278; DOI: https://doi.org/10.3174/ajnr.A7596
G. Biddle
aFrom the Neuroradiology Division (G.B., L.H.-B.), Department of Radiology, University of California Davis School of Medicine, Sacramento, California
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R. Assadsangabi
bNeuroradiology Division (R.A.), Department of Radiology, University of Southern California, Los Angeles, California
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K. Broadhead
cDepartment of Statistics (K.B.), University of California Davis, Davis, California
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L. Hacein-Bey
aFrom the Neuroradiology Division (G.B., L.H.-B.), Department of Radiology, University of California Davis School of Medicine, Sacramento, California
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V. Ivanovic
dNeuroradiology division (V.I.), Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Abstract

BACKGROUND AND PURPOSE: Diagnostic errors affect 2%–8% of neuroradiology studies, resulting in significant potential morbidity and mortality. This retrospective analysis of a large database at a single tertiary academic institution focuses on diagnostic misses in cerebrovascular pathology and suggests error-reduction strategies.

MATERIALS AND METHODS: CT and MR imaging reports from a consecutive database spanning 2015–2020 were searched for errors of attending physicians in cerebrovascular pathology. Data were collected on missed findings, study types, and interpretation settings. Errors were categorized as ischemic, arterial, venous, hemorrhagic, and “other.”

RESULTS: A total of 245,762 CT and MR imaging neuroradiology examinations were interpreted during the study period. Vascular diagnostic errors were present in 165 reports, with a mean of 49.6 (SD, 23.3) studies on the shifts when an error was made, compared with 34.9 (SD, 19.2) on shifts without detected errors (P < .0001). Seventy percent of examinations occurred in the hospital setting; 93.3% of errors were perceptual; 6.7% were interpretive; and 93.9% (n = 155) were clinically significant (RADPEER 2B or 3B). The distribution of errors was arterial and ischemic each with 33.3%, hemorrhagic with 21.8%, and venous with 7.5%. Most errors involved brain MR imaging (30.3%) followed by head CTA (27.9%) and noncontrast head CT (26.1%). The most common misses were acute/subacute infarcts (25.1%), followed by aneurysms (13.7%) and subdural hematomas (9.7%).

CONCLUSIONS: Most cerebrovascular diagnostic errors were perceptual and clinically significant, occurred in the emergency/inpatient setting, and were associated with higher-volume shifts. Diagnostic errors could be minimized by adjusting search patterns to ensure vigilance on the sites of the frequently missed pathologies.

ABBREVIATIONS:

ACA
anterior cerebral artery
PCA
posterior cerebral artery
QA
quality assurance
  • © 2022 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 43 (9)
American Journal of Neuroradiology
Vol. 43, Issue 9
1 Sep 2022
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Diagnostic Errors in Cerebrovascular Pathology: Retrospective Analysis of a Neuroradiology Database at a Large Tertiary Academic Medical Center
G. Biddle, R. Assadsangabi, K. Broadhead, L. Hacein-Bey, V. Ivanovic
American Journal of Neuroradiology Sep 2022, 43 (9) 1271-1278; DOI: 10.3174/ajnr.A7596

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Diagnostic Errors in Cerebrovascular Pathology: Retrospective Analysis of a Neuroradiology Database at a Large Tertiary Academic Medical Center
G. Biddle, R. Assadsangabi, K. Broadhead, L. Hacein-Bey, V. Ivanovic
American Journal of Neuroradiology Sep 2022, 43 (9) 1271-1278; DOI: 10.3174/ajnr.A7596
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