Accuracy of Preliminary Interpretation of Neurologic CT Examinations by On-Call Radiology Residents and Assessment of Patient Outcomes at a Level I Trauma Center

Purpose

The aims of this study were to evaluate the accuracy of preliminary interpretations of emergency neurologic CT scans after hours by on-call radiology residents and to assess the clinical impact of residents' errors at a level I trauma center.

Methods

A quality assurance database of neurologic CT examinations was reviewed to compare preliminary interpretations by on-call residents with final analyses by attending neuroradiologists during a 12-month period. All disagreements were reviewed for confirmation of the findings and categorized as significant or nonsignificant. Significant errors were further classified as acute intracranial, acute extracranial, and nonacute. Medical records for scans with significant errors were reviewed to evaluate any negative impact on the patient for each significant case. Residents' postgraduate years were also recorded.

Results

There were 252 cases (3.7%) with disagreements among 6,852 total cases. Of those, 226 (3.3%) were confirmed as resident errors, which included 171 (2.5%) that were significant. There were 73 (1.1%) acute intracranial, 77 (1.1%) acute extracranial, and 21 (0.3%) nonacute misinterpretations. Among the 171 significant cases, 105 (1.5%) had no changes in clinical management, and 55 (0.8%) required some changes.

Conclusion

The rate of significant errors by on-call radiology residents was low. These errors had a minimal impact on clinical outcomes. Continued monitoring of residents' performance is important to maintain or improve patient safety.

Key Words: Discrepancy, preliminary, CT, accuracy, emergency