Dean A. McNaughton MD, Presenter: Nothing to Disclose

Bao H. Do MD, Abstract Co-Author: Nothing to Disclose

Andrew Wu MD, Abstract Co-Author: Nothing to Disclose

Joan Elizabeth Maley MD, Abstract Co-Author: Nothing to Disclose

To identify the most commonly missed findings by radiology residents in an emergency room call setting.

A computer-generated search engine was designed to search for key words within the hospital’s electronic record. In a one year period (2006-2007), we obtained over 33,000 finalized radiology reports associated with emergency room visits. Reports that disagreed with the preliminary reading contained a “report disagree” template. The search engine identified a phrase in this template and produced matches corresponding to resident “misses.” The first 500 raw matches were displayed as highlighted keywords within each report's impression. The impression for each match was read by a single radiology resident, who removed “false matches.” True matches were considered findings, and these were characterized by their location, appearance, presence of other findings, urgency, imaging modality, and specialty scope. Findings described as "possible" were removed. This left 336 missed findings. Findings and associated characteristics were then analyzed for trends and associations.

The top five most commonly missed findings are as follows: 1. A finding associated with one or more other findings, i.e. “the next finding” (Misses = 185) 2. Fractures (Misses = 59): most commonly involving facial bones, transverse processes, or ribs. 3. Hypo- or hyperdense "lesions" (26): usually liver or kidney lesions 4. Nodules (misses = 20): most were pulmonary nodules 5. GI wall thickening or fat-stranding (misses = 15)

Most of the missed ER findings by on-call residents are either “the next finding” or fractures. These two misses often co-exist and there is a clear separation between these and the next most commonly missed findings. “Satisfaction of search” is the implied cause for many unidentified findings.

Satisfaction of search is the likely etiology for most ER on-call radiology resident misses.

McNaughton, D, Do, B, Wu, A, Maley, J, Top 5 Missed Findings by Residents On-Call for the Emergency Room.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5009987.html