Erica Riedesel MD, Presenter: Nothing to Disclose

Michele M. Walters MD, Abstract Co-Author: Nothing to Disclose

Interpretation of pediatric musculoskeletal radiographs can be challenging for residents new to pediatric imaging. Unique fracture patterns, variation in the appearance of the growing skeleton with age, and the prevalence of normal developmental variants may pose diagnostic dilemmas. The purpose of this study was to determine the most common errors made by residents in the interpretation of pediatric musculoskeletal radiographs from the emergency department.

22,086 radiographs performed after hours in the emergency department at a tertiary care pediatric hospital over a 2-year period (2010- 2012) were analyzed retrospectively. Initial interpretation was performed independently by on-call radiology residents (PGY3-4), with final interpretation by pediatric attending radiologists. Musculoskeletal radiographs, defined as radiographs of the appendicular and axial skeleton, were seperated from this group and further analyzed to determine the type and incidence of missed pathology.

Nearly one third of resident diagnostic errors (29%, 172/591) involved musculoskeletal imaging studies. Musculoskeletal studies were also the most common error encountered resulting in a potential change of clinical management. Evaluation of fractures accounted for 97% of errors (166/172). Digit fractures were most frequently missed (27%), followed by elbow fractures (16%). Pathology unique to pediatrics was frequently encountered, including Salter-Harris fractures (14%), buckle fractures (12%), and normal anatomic variants (8%).

Musculoskeletal radiographs account for a significant proportion of diagnostic errors made by radiology residents interpreting emergency department studies in an on-call setting. These errors are often of a higher severity level, and missed diagnoses impact clinical management of patients. A proactive approach to resident education focusing on common musculoskeletal diagnostic errors can familiarize trainees with frequently missed entities and potentially decrease diagnostic error rate.

A proactive approach to resident education focusing on common musculoskeletal radiography diagnostic errors can familiarize trainees with frequently missed entities and decrease diagnostic error rate.

Riedesel, E, Walters, M, Diagnostic Errors by Radiology Residents in On-call Interpretation of Emergent Pediatric Musculoskeletal Radiographs.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045782.html