Discrepancies in interpretation of night-time emergency computed tomography scans by radiology residents

In many emergency radiology units, most of the night-time work is performed by radiology residents. Residents' preliminary reports are typically reviewed by an attending radiologist. Accordingly, it is known that discrepancies in these preliminary reports exist.

To evaluate the quality of night-time computed tomography (CT) interpretations made by radiology residents in the emergency department.

Retrospectively, 1463 initial night-time CT interpretations given by a radiology resident were compared to the subspecialist's re-interpretation given the following weekday. All discrepancies were recorded and classified into different groups regarding their possible adverse effect for the emergency treatment. The rate of discrepancies was compared between more and less experienced residents and between different anatomical regions.

The overall rate of misinterpretations was low. In 2.3% (33/1463) of all night-time CT interpretations, an important and clinically relevant diagnosis was missed. No fatalities occurred due to CT misinterpretations during the study. The total rate of discrepancies including clinically irrelevant findings such as anatomical variations was 12.2% (179/1463). Less experienced residents were more likely to miss the correct diagnosis than more experienced residents (18.3% vs. 10.9%, odds ratio [OR] = 1.82, P = 0.001). Discrepancies were more common in body CT interpretations than in neurological CTs (18.1% vs. 9.1%, OR = 2.30, P < 0.0001).

The rate of clinically important misinterpretations in CT examinations by radiology residents was found to be low. Experience helps in lowering the rate of misinterpretations.