title: Clinical impact of diagnostic imaging discrepancy by radiology trainees in an urban teaching hospital emergency department.
abstract: BACKGROUND
  To characterize clinically significant diagnostic imaging (DI) discrepancies by radiology trainees and the impact on emergency department (ED) patients.
  
  
  METHODS
  Consecutive case series methodology over a 6-month period in an urban, tertiary care teaching hospital. Emergency physicians (EPs) were recruited to flag discrepant DI interpretations by radiology trainees that the EP deemed clinically significant. Cases were characterized using chart review and EP interview.
  
  
  RESULTS
  Twenty-eight discrepant reports were identified (representing 0.1% of 18,185 images interpreted). The mean time between provisional discrepant diagnosis (PDDx) and revised diagnosis (RDx) by attending radiology staff was 8.6 h (median 4.8 h, range 1.1-48.4), and 67.9% (n = 19) of the patients had left the ED by time of notification. The most frequently reported PDDx was CT abd/pelvis (32.1%, n = 9) and CT head (28.6%, n = 8). The impact of RDx was deemed major in 57.1% (n = 16) for reasons including altered admitting status (32.1%, n = 9), immediate subspecialty referral (n = 16, 57.1%), impact on management (25%, n = 7), and surgical management (21.4%, n = 6). EPs reported likely perceived impact of PDDx as resulting in increased pain (17. 9%, n = 5), morbidity (10.7%, n = 3), and prolonged hospitalization (25%, n = 7), but not altered long-term outcome or mortality.
  
  
  CONCLUSIONS
  Relatively few clinically important discrepant reads were reported. Revised diagnosis (RDx) was associated with major clinical impact in 57.1% of reports, but few patients experienced increased morbidity, and none increased mortality. The importance of expedient communication of discrepant reports by staff radiologists is stressed, as is EP verification of patient contact information prior to discharge.
authors.affiliation: Emergency Medicine - University Health Network, Faculty of Medicine, University of Toronto, RFE G-S434, 200 Elzaibeth Street, Toronto, Ontario M5G 2C4, Canada. steven.friedman@utoronto.ca.
authors.forename: Steven Marc
authors.initials: SM
authors.lastname: Friedman
authors.forename: Erica
authors.initials: E
authors.lastname: Merman
authors.forename: Amit
authors.initials: A
authors.lastname: Chopra