Emergency imaging discrepancy rates at a level 1 trauma center: identifying the most common on-call resident "misses"

The focus of our research is to identify the most frequently reported on-call discrepancies at our hospital by modality and level of resident training. Our intent is to identify specific areas of concern that may be amenable to improvement through initiation of dedicated resident training in the field of emergency radiology. Our study included 648 significant discrepancies from 193,722 studies ordered through the emergency department over a 7-year period. The overall discrepancy rates were calculated for each resident level of training and modality type. Significance was determined using χ2 testing with α = 0.05. The most common types of discrepancies were identified. The overall rate of reported discrepancies was low for all levels of training (0.23-0.42 %) with a small, but statistically significant, decrease in rate for the senior residents. Common categories of discrepancies for all residents included fractures on radiographs (XR) and computed tomography (CT), masses and hemorrhage on CT, and lung nodules and pulmonary infiltrates on radiographs. Specific discrepancies reported more frequently for new call-takers included phalangeal fractures on XR as well as white matter disease, hepatic lacerations, pyelonephritis, peritoneal fluid, lymphadenopathy, and pneumothoraces on CT. It is our recommendation that radiology resident training programs ensure that the common discrepancies illustrated herein are specifically addressed as part of a dedicated emergency radiology course.