title: Preliminary reports in the emergency department: is a subspecialist radiologist more accurate than a radiology resident?
abstract: OBJECTIVE
  To determine whether emergency department (ED) preliminary reports rendered by subspecialist attending radiologists who are reading outside their field of expertise are more accurate than reports rendered by radiology residents, and to compare error rates between radiologists and nonradiologists in the ED setting.
  
  
  METHODS
  The study was performed at a large academic medical center with a busy ED. An electronic preliminary report generator was used in the ED to capture preliminary interpretations rendered in a clinical setting by radiology residents, junior attendings (within 2 years of taking their oral boards), senior attendings, and ED clinicians between August 1999 and November 2004. Each preliminary report was later reviewed by a final interpreting radiologist, and the preliminary interpretation was adjudicated for the presence of substantial discordances, defined as a difference in interpretation that might immediately impact the care of the patient. Of the 612,890 preliminary reports in the database, 65,780 (11%) met inclusion criteria for this study. A log-linear analysis was used to assess the effects of modality and type of author on preliminary report error rates.
  
  
  RESULTS
  ED clinicians had significantly higher error rates when compared with any type of radiologist, regardless of modality. Within the radiologists, residents and junior attendings had lower error rates than did senior attendings, but the differences were not statistically significant.
  
  
  CONCLUSIONS
  Subspecialized attending radiologists who interpret ED examinations outside their area of expertise have error rates similar to those of radiology residents. Nonradiologists have significantly higher error rates than radiologists and radiology residents when interpreting examinations in the ED.
authors.affiliation: Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, PUH Room D132, Pittsburgh, PA 15213, USA. bfb1@pitt.edu
authors.forename: Barton F
authors.initials: BF
authors.lastname: Branstetter
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Morgan
authors.forename: Chadd E
authors.initials: CE
authors.lastname: Nesbit
authors.forename: Jinnah A
authors.initials: JA
authors.lastname: Phillips
authors.forename: David M
authors.initials: DM
authors.lastname: Lionetti
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chang
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Towers
mesh_terms: D002983:Clinical Competence; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital; D006801:Humans; D007396:Internship and Residency; D016014:Linear Models; D008505:Medical Staff, Hospital; D008511:Medicine; D011872:Radiology Department, Hospital / Q000592:standards*; D013038:Specialization; D000078329:Workforce