Emergency Computed Tomography: What is Missed at First Reading?

Area of Science:

• Radiology
• Medical Education
• Emergency Medicine

Background:

• Preliminary interpretations of computed tomography (CT) scans in emergency departments are performed by radiology residents.
• Assessing the accuracy of these initial interpretations is crucial for patient care and resident training.

Purpose of the Study:

• To evaluate the accuracy of preliminary CT interpretations by emergency department radiology residents.
• To identify factors influencing the rate of interpretation disparities.

Main Methods:

• Attending radiologists prospectively compared their interpretations to residents' preliminary reads over 4 periods.
• Disparities were categorized as major if related to potentially life-threatening conditions.
• Analysis included CT examination type (body vs. neuro) and time of interpretation (working vs. on-call hours).

Main Results:

• A total of 3044 emergency CT examinations were analyzed.
• Overall disparity rate was 4.8% (145/3044), with 0.8% (24/3044) classified as major misinterpretations.
• Disparities were significantly higher in body CT (6.3%) compared to neurological CT (3.0%).

Conclusions:

• Emergency body CT interpretations by residents showed a higher rate of disparities compared to neurological CT.
• Major misinterpretations constituted a small fraction of all interpretation errors.
• Findings provide a benchmark for optimizing resident training in emergency radiology.