Value of radiograph audit in an accident service department

In our accident service department all trauma radiographs are reported acutely and those misinterpreted by the casualty officers are presented at the daily clinicoradiological conference. We have reviewed this practice over a 6-month period. From over 25,000 patients attending the accident service, 16,246 radiographs were requested and reported. Of these, 456 (2.8 per cent) were considered to have been potentially misinterpreted. The errors included 167 (1 per cent) missed fractures, 55 (0.3 per cent) suspected fractures and 72 (0.4 per cent) false-positive diagnoses of fracture. Subsequently, 114 (0.7 per cent) patients required recall for treatment or further imaging. Incorrect diagnoses were seen most frequently in the more commonly injured anatomical sites--the ankle, wrist, foot, elbow and hand. However, the incidence of misinterpretation was highest in examination of the fingers, especially in children. We believe that these low figures are principally the result of involving both orthopaedic surgeons and radiologists at the formal daily conference. We regard our system of audit as beneficial to patients' care and anticipate reduced litigation which may offset the increased cost of audit.