Etiology and disposition associated with radiology discrepancies on emergency department patients

Liza Gergenti, Robert P. Olympia

Research output: Contribution to journalArticle

Abstract

Background: Diagnostic errors made by radiology resident physicians may lead to significant morbidity/mortality and patient dissatisfaction. Objective: To determine the etiology and disposition associated with radiology discrepancies on emergency department (ED) patients. Methods: We conducted a retrospective electronic chart review of patients presenting to our ED during “off hours” at the Penn State Hershey Medical Center during October 2013–November 2014 and had a radiology discrepancy, defined as a patient discharged from the ED with a diagnostic interpretation disagreement between the initial radiology resident physician read and final radiology attending physician read. Results: 81,201 images were performed during “off hours”, with 174 radiology discrepancies (0.214%) identified. Most discrepancies were associated with CT scans (62%). The most common final diagnostic interpretations associated with discrepancies were missed fracture (10.9%), incidental findings of mass or cyst (10.3%), gastrointestinal inflammation (6.3%), and pneumonia (5.7%). 10% of radiology discrepancies were instructed to emergently return to the ED. The most common modality associated with ED follow-up was CT scan of the abdomen/pelvis (50%). Of the 17 patients that returned to the ED, 10 had additional diagnostic imaging, 9 received a subspecialist consult, 5 required surgical treatment, 5 required additional medications, and 1 required a medical hospitalization. Conclusions: Based on our sample, discrepancies were a small percentage of images performed during “off hours”, and were associated with CT scans, missed fractures, and non-emergent outpatient follow-up. We suggest that ED and radiology departments work collaboratively to monitor their own rates of discrepancies, and subsequent morbidities and mortalities, to improve patient care.

Original languageEnglish (US)
Pages (from-to)2015-2019
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume37
Issue number11
DOIs
StatePublished - Nov 2019

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Radiology
Hospital Emergency Service
Physicians
Morbidity
Incidental Findings
Mortality
Diagnostic Imaging
Diagnostic Errors
Pelvis
Abdomen
Cysts
Pneumonia
Patient Care
Hospitalization
Outpatients
Inflammation

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

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title = "Etiology and disposition associated with radiology discrepancies on emergency department patients",
abstract = "Background: Diagnostic errors made by radiology resident physicians may lead to significant morbidity/mortality and patient dissatisfaction. Objective: To determine the etiology and disposition associated with radiology discrepancies on emergency department (ED) patients. Methods: We conducted a retrospective electronic chart review of patients presenting to our ED during “off hours” at the Penn State Hershey Medical Center during October 2013–November 2014 and had a radiology discrepancy, defined as a patient discharged from the ED with a diagnostic interpretation disagreement between the initial radiology resident physician read and final radiology attending physician read. Results: 81,201 images were performed during “off hours”, with 174 radiology discrepancies (0.214{\%}) identified. Most discrepancies were associated with CT scans (62{\%}). The most common final diagnostic interpretations associated with discrepancies were missed fracture (10.9{\%}), incidental findings of mass or cyst (10.3{\%}), gastrointestinal inflammation (6.3{\%}), and pneumonia (5.7{\%}). 10{\%} of radiology discrepancies were instructed to emergently return to the ED. The most common modality associated with ED follow-up was CT scan of the abdomen/pelvis (50{\%}). Of the 17 patients that returned to the ED, 10 had additional diagnostic imaging, 9 received a subspecialist consult, 5 required surgical treatment, 5 required additional medications, and 1 required a medical hospitalization. Conclusions: Based on our sample, discrepancies were a small percentage of images performed during “off hours”, and were associated with CT scans, missed fractures, and non-emergent outpatient follow-up. We suggest that ED and radiology departments work collaboratively to monitor their own rates of discrepancies, and subsequent morbidities and mortalities, to improve patient care.",
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Etiology and disposition associated with radiology discrepancies on emergency department patients. / Gergenti, Liza; Olympia, Robert P.

In: American Journal of Emergency Medicine, Vol. 37, No. 11, 11.2019, p. 2015-2019.

Research output: Contribution to journalArticle

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