Determining the clinical significance of errors in pediatric radiograph interpretation between emergency physicians and radiologists

Objectives: Emergency physicians (EPs) interpret plain radiographs for management and disposition of patients. Radiologists subsequently conduct their own interpretations, which may differ. The purposes of this study were to review the rate and nature of discrepancies between radiographs interpreted by EPs and those of radiologists in the pediatric emergency department, and to determine their clinical significance. Methods: We conducted a retrospective review of discrepant radiology reports from a single-site pediatric emergency department from October 2012 to December 2014. All radiographs were interpreted first by the staff EP, then by a radiologist. The report was identified as a discrepancy if these reports differed. Radiographs were categorized by body part and discrepancies classified as false positive, false negative, or not a discrepancy. Clinically significant errors that required a change in management were tracked. Results: There were 25,304 plain radiographs completed during the study period, of which 252 (1.00%) were identified as discrepant. The most common were chest radiographs (41.7%) due to missed pneumonia, followed by upper and lower extremities (26.2% and 17.5%, respectively) due to missed fractures. Of the 252 discrepancies, 207 (82.1%) were false negatives and 45 (17.9%) were false positives. In total, 105 (0.41% of all radiographs) were clinically significant. Conclusion: There is a low rate of discrepancy in the interpretation of pediatric emergency radiographs between emergency department physicians and radiologists. The majority of errors occur with radiographs of the chest and upper extremities. The low rate of clinically significant discrepancy allows safe management based on EP interpretation.