Richard B. Ruchman MD, Presenter: Nothing to Disclose

Joseph Jaeger, Abstract Co-Author: Nothing to Disclose

Syndi Seinfeld, Abstract Co-Author: Nothing to Disclose

Ernest Wiggins MD, Abstract Co-Author: Nothing to Disclose

Vikas Thakral MD, Abstract Co-Author: Nothing to Disclose

Sudha Bolla MD, Abstract Co-Author: Nothing to Disclose

Sara Wallach MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

At academic institutions, overnight emergency radiology examinations are read by the “on call” resident and reviewed by an attending radiologist in the morning. Our objective is to describe the rate of discrepancies between the two readings and the possible effect on patient care.

The preliminary reports for 11,809 emergency cases performed after hours by residents over a three year period were reviewed for any discrepancy with the final attending interpretation. The radiologists reviewing the on call cases were not necessarily specialists in that particular sub-specialty. A discrepancy was noted if verbal notification of the ordering physician was required. An internal medicine resident / attending team retrospectively reviewed the charts of the major discrepancy cases to identify both the clinical indication / medical necessity of the examination and the effect of the preliminary interpretation on patient management. The discrepancies were categorized as having no effect, some negative effect, or an important negative effect, based on the impact of a delayed diagnosis on patient morbidity.

The overall major discrepancy rate was 2.6 %. The most common modality involved was contrast enhanced CT of the abdomen and pelvis, with the most common diagnosis related to acute appendicitis, at 6.4 %. The rate of discrepancy was highest within the second year of training. Indications for these examinations were varied, however the effect on patient management was found to be 90.7 % no effect, 8.8 % some negative effect, and 0.5 % important negative effect.

This discussion highlights the minimal discrepancy rate that occurs with overnight resident coverage at an academic institution. As such, there is limited detrimental effect of relying on radiology resident preliminary interpretations. The results of this study are consistent with others in the literature, however this evaluation is unique in the number of cases reviewed, and modalities covered. These data may be used to identify and further limit future discrepancies, which should improve resident education, clinical performance, and patient care.

Ruchman, R, Jaeger, J, Seinfeld, S, Wiggins, E, Thakral, V, Bolla, S, Wallach, S, et al, , Comparison of Preliminary Radiology Resident Interpretations versus Final Attending Interpretations and the Impact on Patient Outcomes in a Community Hospital.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4406590.html