Radiology Callbacks to a Pediatric Emergency Department and Their Clinical Impact

Background Clinical impact of radiology callbacks (missed initial radiologic diagnosis) remains largely unknown in the pediatric emergency department (PED). Objective The aim of this study was to describe the incidence, nature of radiology callbacks, and the impact on clinical care during the return visit (RV). Methods We performed a retrospective chart review of quality assurance database of RVs for radiology callbacks to our PED over a 1-year period. Results Return visit rate to our PED was 3% (2765/92,000) of which 1.9% (55/2765) was for radiology callbacks. Radiology misses involved mostly x-ray interpretations (92.7%), occurred after-hours (83.6%), with fractures being the most common missed finding. Majority of patients (94.5%) required 1 or more interventions during the RV; 34.5% of radiology callbacks had a major impact on clinical management; 27.2% of radiology callbacks were false-positive. Conclusions Although RVs secondary to radiology callback remain low, one third of them resulted in major changes in diagnosis, treatment, or disposition and impacted patient outcome.