Etiology and disposition associated with radiology discrepancies on emergency department patients

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. (C) 2019 Elsevier Inc. All rights reserved.