Original articleAccuracy of Preliminary Interpretation of Neurologic CT Examinations by On-Call Radiology Residents and Assessment of Patient Outcomes at a Level I Trauma Center
Section snippets
Study Design
We reviewed the QA data from April 10, 2006, to April 8, 2007. Preliminary interpretations of 6,859 neurologic CT examinations were provided by on-call radiology residents on-site in the ED at Harborview Medical Center. Our institution is the only level I trauma center for 5 northwestern states (Washington, Wyoming, Alaska, Montana, and Idaho), covering 25% of the US land mass. The neurologic CT examinations during off hours consisted of head CT (80%), maxillofacial CT (9%), head CT angiography
Results
Of the 6,859 cases imaged during the study period, 5 were excluded because of incomplete data, 1 because of a lack of clarification of the discrepant interpretation in the final report, and 1 because of the attending neuroradiologist's revision of his conclusion from “disagree” to “agree.”
Discussion
In our study, significant (class I) resident errors were found in 2.5% of all after-hours neurologic CT examinations during the 1-year study period. Patients' clinical management and courses were altered in about one-third of these class I errors (0.8% of all patients). We found no data in the literature to compare with this finding. Several studies have reported similar radiology resident error rates [1, 2, 3, 4, 5, 6, 7] (Table 2), but the data are not comparable between studies for several
Conclusion
The rate of resident misses and misinterpretations was 2.5% for significant misses at this high-volume level I trauma center with a high rate of CT examinations with positive results. The rate was comparable with the rate of disagreement by nighthawks using teleradiology for emergency head CT. Changes in patient management or outcomes were observed in <1% of cases. The most frequent misinterpretation was of subtle intracranial hemorrhage. The continual monitoring of resident error rates as a
Acknowledgment
We would like to acknowledge Martin Gunn, MD, and Marie Leonard for their contributions to the completion of this article and editorial assistance.
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