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Reporting Discrepancy Resolved by Findings and Time in 2947 Emergency Department Ankle X-rays.

Thomas James York1, P J Jenkins2, A J Ireland2

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|November 23, 2019
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Summary

Initial ankle X-ray reporting is generally accurate, but missed fractures like navicular and cuboid highlight the need for senior review. Errors increase outside of normal working hours, especially late at night.

Keywords:
Ankle fracturesReporting discrepancyReporting errorsTime resolved discrepancyX-ray reporting

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Area of Science:

  • Radiology
  • Orthopedic Surgery
  • Medical Error Analysis

Background:

  • Ankle X-ray interpretation is crucial for diagnosing fractures.
  • Virtual fracture clinics aim to streamline patient care and follow-up.
  • Discrepancies between initial and final reports can impact patient management.

Purpose of the Study:

  • To identify common errors in initial ankle X-ray reporting compared to final assessments.
  • To determine if the time of initial reporting influences reporting accuracy.

Main Methods:

  • Review of 2,947 ankle X-ray reports for agreement between initial and final interpretations.
  • Classification and collation of discrepancies by specific findings.
  • Analysis of reporting errors based on time of day, comparing out-of-hours to in-hours reporting.

Main Results:

  • 94.4% of reports showed agreement; 2.9% minor and 2.7% major discrepancies.
  • Significant rates of missed navicular (40.0%) and cuboid (33.3%) fractures in initial reports.
  • Increased major discrepancies noted between 00:00-07:59 and minor discrepancies between 20:00-23:59.

Conclusions:

  • Initial ankle X-ray reporting is of high standard but requires senior review for serious missed findings.
  • Specific fractures (navicular, cuboid, talar, Weber A) are disproportionately missed.
  • Reporting errors, particularly minor discrepancies, are more frequent outside standard working hours (17:00-07:59).