Asako Miyakoshi MD, Presenter: Nothing to Disclose

Quinh T. Nguyen, Abstract Co-Author: Nothing to Disclose

Wendy A. Cohen MD, Abstract Co-Author: Nothing to Disclose

Martin Lee David Gunn MBChB, Abstract Co-Author: Nothing to Disclose

Lee B. Talner MD, Abstract Co-Author: Nothing to Disclose

Yoshimi Anzai MD, Abstract Co-Author: Nothing to Disclose

Accuracy of preliminary reports by on-call residents is one of the benchmarks for rigorous clinical training and quality assurance (QA) in academic medical institutions. The purpose of this study is to address accuracy of resident-generated preliminary reports as well as impact of misses and misinterpretations on patient clinical outcomes in a Level 1 trauma center.

From July 01, 06 to January 15, 07, 4020 head CT, neck CT and CTA cases were interpreted by on-call residents off hours. As a part of on-going hospital QA process, all preliminary reports were reviewed by attending neuroradiologists within 12 hours. Discrepancies were graded as follows; acute intracranial discrepancy (AID), acute extracranial discrepancy (AED), non acute discrepancy (NAD). Discrepancies were reviewed with subsequent imaging and/or clinical information to confirm residents misses and misinterpretation vs attending overcall. For the cases of confirmed resident misses and misinterpretation, medical charts were reviewed to assess adverse clinical outcomes.

Among 4020 neuro CT cases read by on-call residents, there were 78 discrepancy cases, including, 26 cases of AID, 29 cases of AED and 23 cases of NAD. Abnormalities noted by attendings were not confirmed to be present in 3 cases. Therefore, 75 cases were considered residents' misses and misinterpretation (1.9%). Among 75 cases, clinical follow-up was available in 60 cases. No effect on outcomes was noted in 49 cases, non-life threatening adverse effect on outcomes was noted in 10 cases (0.25%), and a potentially life threatening adverse outcome was noted in 1 case (0.02%).

The rate of misses and misinterpretation by on-call residents of neuro CT examinations is exceedingly low in a high volume level 1 trauma center. This is, in part, due to rigorous clinical training of emergency neuroradiology. There was only 1 out of 4020 cases where misinterpretation could lead to potentially life-threatening adverse clinical outcomes (0.02%).

Residents overnight coverage of emergency neuroimaging in a level I trauma center provides accurate interpretation and has no significant adverse effect on patient well beings.

Miyakoshi, A, Nguyen, Q, Cohen, W, Gunn, M, Talner, L, Anzai, Y, Accuracy of Preliminary Interpretation by Oncall Residents on Neuro CT Examination and Assessment of Patient Outcomes.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5009760.html