Emergency physicians make more mistakes when interpreting imaging of multiple organs
Emergency physicians may be more susceptible to CT scan interpretation errors when their patients undergo studies analyzing multiple organs, such as in whole-body trauma scans.
Although radiologists hold the primary responsibility of interpreting imaging, staffing shortages, high CT utilization rates and time constraints can make it challenging for rads to read emergency scans in a timely manner. As such, many emergency medicine physicians will review their own imaging prior to them being interpreted by a qualified radiologist, raising the possibility of errors. These mistakes, though uncommon, can sometimes alter treatment plans and delay appropriate interventions.
A new paper in Emergency Radiology details the prevalence of interpretation errors in emergency departments, the factors that influence them and how they affect patient care.
“Despite the rapid adoption of high-performance multi-detector CT scanners, radiologists in small community hospitals, particularly in rural areas, face challenges in interpreting images in real time,” Takafumi Yonemitsu MD, PhD, with the department of emergency and critical care medicine at Wakayama Medical University, in Japan, and colleagues explained. “Although [emergency providers] expect radiologists to cover image interpretation beyond their areas of expertise, the availability of emergency radiology services, including teleradiology, varies significantly across hospitals.”
The group retrospectively reviewed more than 2,000 cases of patients who had consecutive ED visits initially managed by EM docs. They compared the initial imaging interpretations to that of emergency radiologists, taking note of errors and if/how they impacted patients’ management.
Of the 2,037 patients, just 8% experienced interpretation errors. Of those, 3% eventually resulted in a change in clinical management. Nearly 90% of the errors by EM physicians were related to underreading.
The team found that multisite imaging—exams of multiple body regions or whole-body scans—was the biggest predictor of errors that affected how patients were managed. Other influencing factors were longer stays in the ED, night visits to the department and the use of contrasted studies, especially those of the abdomen and pelvis.
“Multisite CT scanning, the strongest risk factor for both [interpretation errors] and IECM, likely increases the potential for abnormal findings due to the wider scan range. Radiologists are trained to interpret these highly informative images comprehensively and mechanically while integrating clinical context,” the authors explained. “However, [emergency providers] must prioritize findings most relevant to immediate clinical concerns and prompt therapeutic decisions. EPs naturally focus their interpretation on anatomical regions linked to the patient’s presenting symptoms.”
The team proposed several solutions for reducing reading errors by EM providers, including staggered staffing models that ensure a radiologist is immediately available to view images in real-time and routinely providing radiological training relevant to emergency departments.
Learn more about their suggestions here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.