title: Discordance in interpretation of chest radiographs between pediatric intensivists and a radiologist: impact on patient management.
abstract: OBJECTIVE
  When radiologists are not available, chest radiographs (CXRs) of pediatric intensive care unit (PICU) patients are commonly interpreted by pediatric intensivists. We prospectively investigated the frequency of errors in CXR interpretation by pediatric intensivists and their impact on patient management.
  
  
  METHODS
  Chest radiographs of PICU patients were evaluated by 5 pediatric intensivists then by a pediatric radiologist (the "gold standard"). If the interpretation of the radiologist and intensivist differed, an independent intensivist determined whether a management change took place. A pediatric pulmonologist determined how many intensivist interpretations were different from the radiologist's interpretations.
  
  
  RESULTS
  Seven hundred twenty-eight radiographic findings were identified by the radiologist in 460 CXRs. There were 33 interpretation errors by the intensivists (4.5% of the findings in 7.1% of the CXRs). Only 3/33 error corrections (0.45% of the findings in 0.7% of the CXRs) resulted in change in patient management.
  
  
  CONCLUSIONS
  Errors in interpretation of CXRs by pediatric intensivists were common but less than that in other series, probably because of education of the pediatric intensivists through daily rounds with the radiologist. Although interpretation errors that affected patient management were rare, their clinical importance supports the growing practice of 24/7 remote radiograph reading by radiologists.
authors.affiliation: Division of Pediatric Critical Care and Pulmonary Medicine, Georgetown University Children's Medical Center, Washington, DC 20007, USA.
authors.forename: Galina V
authors.initials: GV
authors.lastname: Nesterova
authors.forename: Clifton A
authors.initials: CA
authors.lastname: Leftridge
authors.forename: Aruna R
authors.initials: AR
authors.lastname: Natarajan
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Appel
authors.forename: Maria V
authors.initials: MV
authors.lastname: Bautista
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Hauser
mesh_terms: D002648:Child; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004219:District of Columbia; D006785:Hospitals, University; D006801:Humans; D015278:Intensive Care Units, Pediatric; D015588:Observer Variation; D010346:Patient Care Management; D010372:Pediatrics / Q000592:standards*; D011446:Prospective Studies; D013902:Radiography, Thoracic; D011871:Radiology / Q000592:standards*