Jonathan Hero Chung MD, Presenter: Nothing to Disclose

Roberta Marie Strigel MD, Abstract Co-Author: Nothing to Disclose

Annemarie Relyea-Chew, Abstract Co-Author: Nothing to Disclose

Emily Albrecht, Abstract Co-Author: Nothing to Disclose

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

At our institution, radiology residents interpret urgent imaging studies performed at a level-one trauma center overnight. These preliminary reports are then reviewed by an attending radiologist the next morning. The aims of our study were to determine the major torso CT discrepancy rate between preliminary resident interpretations and final attending interpretations, and to identify adverse patient effects secondary to the initially incorrect diagnosis.

All torso CT studies interpreted by the weekday night resident over 2 years were retrospectively evaluated. Discrepancies between the resident interpretation and attending interpretation were addended by the attending radiologist. All major discrepancies (those which could potentially affect patient care) were additionally reviewed by two radiology residents and an emergency radiology attending. The medical records of patients with major discrepant findings were reviewed to identify adverse effects that occurred due to the delay in final interpretation.

4786 chest, abdomen, and pelvis CT studies were interpreted during the study period. 114 reports were recorded as major discrepancies. In 15/114 (13.1%) cases, two additional residents and an ER radiology attending agreed with the initial resident interpretation. The major discrepancy rate, when accounting for these attending errors, decreased to 99/4786 (2.1%), which is consistent with data from the literature (0.4-10%). Management was changed in 16/4786 (0.3%) patients due to these major discrepancies, including 13 additional investigations and 3 patients recalled to the emergency room. No mortality or morbidity was directly attributed to a delay in diagnosis.

At our institution, there is a low torso CT disagreement rate between resident preliminary interpretation and attending final interpretation. There are few additional interventions as a result of the major discrepancies, without directly attributable adverse patient effect. In major discrepant cases, there is a 13.1% inter-attending discrepancy rate, suggesting that these cases are complex. As there is learning value for the residents in overnight interpretation, independent radiology resident coverage should continue.

Independent radiology resident coverage should continue as it is an invaluable educational experience, and results in little additional patient morbidity or mortality.

Chung, J, Strigel, R, Relyea-Chew, A, Albrecht, E, Gunn, M, Overnight Resident Interpretation of Torso CT and CTA at a Level 1 Trauma Center: Is the Resident-Attending Discrepancy Rate Too High?.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6007065.html