Radiological review of accident and emergency radiographs: a 1-year audit.
OBJECTIVE
To assess the impact and cost effectiveness of a system of radiological review of accident and emergency (A&E) plain films.


METHODS
Review documentation was studied retrospectively over a 1-year period. Six hundred and eighty-four actual or suspected errors in the initial radiological interpretation by A&E staff were highlighted by radiologists in training. These selected 'red reports' were then further reviewed by a musculoskeletal radiologist and a more senior member of the A&E team.


RESULTS
Three hundred and fifty-one missed or strongly suspected fractures were detected, with ankle, finger and elbow lesions predominating. Other errors included 11 missed chest radiograph abnormalities and 24 A&E false-positives. Radiologists in training tended to over-report abnormalities with an 18% false-positive rate when compared to the subsequent musculoskeletal radiology opinion. Following review, further action was taken by A&E staff in 286 (42.6%) of cases. No operative intervention was required in those patients with a delayed or missed A&E diagnosis. Consideration is given to the cost of providing this form of review and the impact of medico-legal factors.


CONCLUSIONS
Compared with the large numbers of patients seen and radiographed in a busy A&E department, the number of radiological errors was small. There were even fewer changes in management. Despite this, concern over litigation, clinical governance and future work patterns in A&E make this form of review a useful means of risk reduction in a teaching hospital.Williams, S. M. (2000). Clinical Radiology55, 861-865
Williams
S M
SM
Department of Radiology, John Radcliffe Hospital, Headington, Oxford, UK.
Connelly
D J
DJ
Wadsworth
S
S
Wilson
D J
DJ
D003362:Cost-Benefit Analysis; D003951:Diagnostic Errors; D004630:Emergencies / Q000191:economics; D004636:Emergency Service, Hospital / Q000191:economics / Q000592:standards*; D004739:England; D050723:Fractures, Bone / Q000000981:diagnostic imaging; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D008485:Medical Audit / Q000191:economics; D011859:Radiography / Q000592:standards*; D011872:Radiology Department, Hospital / Q000592:standards*; D012189:Retrospective Studies