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Interpretation of pediatric x-ray films by emergency department pediatricians
Insights
Emergency department pediatricians accurately interpret most pediatric roentgenograms, agreeing with radiologists in 91.1% of cases. Areas for improvement include subtle fractures and incidental findings.
Area of Science:
- Pediatric Radiology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Pediatric emergency departments frequently utilize radiographic studies for diagnosis.
- Accurate interpretation of these roentgenograms is crucial for timely and appropriate patient care.
Purpose of the Study:
- To compare the diagnostic accuracy of pediatric roentgenogram interpretations between emergency department pediatricians and radiologists.
- To identify specific areas where pediatricians' interpretations may differ from radiologists'.
Main Methods:
- A retrospective review of 564 pediatric radiographic studies (chest, extremities, skull, abdomen, miscellaneous) was conducted.
- Interpretations by emergency department pediatricians were compared with those of radiologists.
- Agreement rates and discrepancies requiring therapeutic changes were analyzed.
Main Results:
- Overall agreement between pediatricians and radiologists was high at 91.1%.
- Only 8.9% of studies showed disagreement, with just 1.2% necessitating therapy changes.
- Pediatricians demonstrated particular difficulty in identifying subtle fractures and incidental abnormalities.
Conclusions:
- Emergency department pediatricians demonstrate significant accuracy in interpreting common pediatric roentgenograms.
- Targeted educational interventions focusing on subtle fractures and incidental findings can enhance diagnostic capabilities.
- This supports the role of pediatricians in initial radiographic interpretation within the emergency setting.
Abstract:
This study compared the interpretation of pediatric roentgenograms by emergency department pediatricians and radiologists. Data were available from 532 of 600 children who had 564 radiographic studies during a six-week period: 217 examinations of the chest, 200 of the extremities, 74 of the skull, 35 of the abdomen, and 38 of miscellaneous structures. The emergency department pediatricians and the radiologists were in agreement in 91.1% of the cases. Among the 50 of 564 (8.9%) discordant studies, only seven (1.2%) required changes in therapy. The results attest to the accuracy of emergency department pediatricians in interpreting the usual types of films ordered in their department. However, this group specifically erred in the identification of subtle fractures and the detection of abnormalities incidental to the primary purpose for which the film was obtained. Future educational programs should address these areas of deficiency.