Diagnostic errors in interpretation of pediatric musculoskeletal radiographs at common injury sites.
BACKGROUND
Extremity pain represents one of the most common reasons for obtaining conventional radiographs in childhood. Despite the frequency of these examinations little is known about the incidence of diagnostic errors by interpreting pediatric radiologists.


OBJECTIVE
The purpose of this study was to develop a standard error rate of pediatric radiologists by double-reading of extremity radiographs (elbow, wrists, knees and ankles) in children presenting with a history of trauma or pain.


METHODS
During a 6-month period all major extremity radiographs (excluding digits) obtained at a large pediatric referral hospital for evaluation of pain or trauma were reviewed by two senior pediatric radiologists and compared to the official interpretation. All radiographs were interpreted initially by a board-certified pediatric radiologist with a Certificate of Added Qualification (CAQ). We reviewed 3,865 radiographic series in children and young adults 2-20 years of age. We tabulated misses and overcalls. We did not assess the clinical significance of the errors.


RESULTS
There were 61 miss errors and 44 overcalls in 1,235 abnormal cases and 2,630 normal cases, for a 1.6% miss rate and a 1.1% overcall rate. Misses and overcalls were most common in the ankle.


CONCLUSIONS
Interpretive errors by pediatric radiologists reviewing certain musculoskeletal radiographs are relatively infrequent. Diagnostic errors in the form of a miss or overcall occurred in 2.7% of the radiographs.
Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Ste. 470, Houston, TX, 77030, USA, gsbisset@texaschildrens.org.
George S
GS
Bisset
James
J
Crowe
D000293:Adolescent; D001134:Arm Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors / Q000517:prevention & control* / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D007869:Leg Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011859:Radiography; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013781:Texas / Q000453:epidemiology; D014962:X-Ray Film / Q000706:statistics & numerical data*; D055815:Young Adult