CT in adults: systematic review and meta-analysis of interpretation discrepancy rates

To use meta-analysis to determine the discrepancy rate when interpreting computed tomography (CT) studies performed in adult patients and to determine whether discrepancy rate differs on the basis of body region or level of radiologist training.

MEDLINE and EMBASE were searched from 1946 to June 2012 by using the combination "radiology AND (error OR peer review)." Two reviewers independently selected studies that met the inclusion criteria and extracted study data. Total and major discrepancy rates were investigated with a random-effects meta-analysis, and subgroups were compared by using the χ(2) Q statistic. Subgroup analyses were performed on the basis of the level of training of the initial radiologist and the body system scanned.

Fifty-eight studies met the inclusion criteria (388 123 CT examinations). The pooled total discrepancy rate was 7.7% (95% confidence interval [CI]: 5.6%, 10.3%), and the major discrepancy rate was 2.4% (95% CI: 1.7%, 3.2%). The pooled major discrepancy rate was comparable for staff (2.9%; 95% CI: 1.2%, 6.7%) and residents (2.2%; 95% CI: 1.7%, 2.9%) (Q = 0.92, P = .633). The pooled major discrepancy rates for head CT (0.8%; 95% CI: 0.4%, 1.6%) and spine CT (0.7%; 95% CI: 0.2%, 2.7%) were lower than those for chest CT (2.8%; 95% CI: 1.5%, 5.4%) and abdominal CT (2.6%; 95% CI: 1.0%, 6.7%) (Q = 8.28, P = .041). Lack of blinding of the reference radiologist to the initial report was associated with a lower major discrepancy rate (2.0%; 95% CI: 1.4%, 2.7%; 43 studies) than when blinding was present (12.1%; 95% CI: 4.4%, 29.4%; five studies) (Q = 10.65, P = .001).

Potentially useful reference ranges were identified in the subgroup analyses on the basis of body region scanned at adult CT. However, considerable heterogeneity that is only partially explained by subgroup analysis signifies that further research is necessary--particularly regarding the question of blinding of the reference radiologist.