title: Accuracy of interpretations of emergency department radiographs: effect of confidence levels.
abstract: We conducted a prospective study to assess the relationship between the interpretive agreement rate for emergency department radiographs and the degree of interpretive confidence. We hoped to identify a subset of ED radiographs that did not require mandatory review by a radiologist. For each of the 1,872 plain radiographs studied, emergency physicians assigned a confidence level to the interpretation before comparing it with the radiologist's dictated report. A second radiologist was consulted to resolve disagreements. The overall rate of interpretive agreement was 94.6%. Agreement varied significantly (P less than .001) as a function of confidence level and by type of radiograph, but not by training level. Agreement varied significantly (P less than .001) as a function of confidence level for some types of radiographs (eg, chest, extremities) and for some types of radiographic findings (acute positive). No subset of radiographs had 100% agreement. Treatment was potentially altered in 38 patients as a result of the interpretive disagreement that occurred in 2% of studied radiographs. We conclude that the interpretive agreement rate increases in relation to interpretive confidence but that confidence levels cannot safely exclude certain radiographs from mandatory review by a radiologist.
authors.affiliation: Emergency Medicine Residency Program, University of Illinois College of Medicine, Peoria.
authors.forename: F E
authors.initials: FE
authors.lastname: Mayhue
authors.forename: D D
authors.initials: DD
authors.lastname: Rust
authors.forename: J C
authors.initials: JC
authors.lastname: Aldag
authors.forename: A M
authors.initials: AM
authors.lastname: Jenkins
authors.forename: J C
authors.initials: JC
authors.lastname: Ruthman
mesh_terms: D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D005121:Extremities / Q000000981:diagnostic imaging; D006801:Humans; D007400:Interprofessional Relations; D011446:Prospective Studies; D011859:Radiography; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic; D011871:Radiology; D012886:Skull / Q000000981:diagnostic imaging; D013131:Spine / Q000000981:diagnostic imaging