Klein E J, Koenig M, Diekema D S, Winters W
Department of Pediatrics, University of Washington, Seattle, USA.
Pediatr Emerg Care. 1999 Aug;15(4):245-8.
To describe the types of discrepancies in radiograph interpretation between emergency physicians and radiologists in a pediatric emergency department, and to determine the impact of discrepant interpretations on patient care.
Prospective cohort study of discordant radiographs from the period beginning March 1, 1995 and ending March 31, 1996. During this period, 2083 radiographs were coded by the radiologist as concordant or discordant. Three hundred forty-nine were coded as discordant, and 324 were eligible for the study. Charts were reviewed for relevant physical examination findings and emergency department management. Discrepancies that affected patient care were deemed clinically significant.
Twenty-three (1.1%) of 2083 radiographs were interpreted differently by the emergency physician and the radiologist in a way that might have changed patient management. This represents 7% (23/324) of the radiographs originally coded by a radiologist as discrepant. The most common discrepancy was a patient with a normal chest examination and a radiograph interpreted as having an infiltrate by the emergency physician, but subsequently read as having no infiltrate by a radiologist (12/324). These patients may have received antibiotics unnecessarily. Two discrepant interpretations had the potential to have serious consequences to the patient if not identified. One patient with cardiomegaly and another patient with free air on abdominal radiograph were not noted by the emergency physician.
Emergency physicians would benefit from more rigorous interpretation of chest x-rays to avoid unnecessary treatment with antibiotics. Emergency physicians do a good job interpreting plain radiographs, but occasionally miss significant findings that could lead to adverse outcomes. The presence of radiologists to immediately read radiographs 24 hours a day could prevent missed findings, but, given the small number of significant misinterpretations, is unlikely to be cost effective.
描述儿科急诊科急诊医生与放射科医生在X光片解读上的差异类型，并确定差异解读对患者治疗的影响。
对1995年3月1日至1996年3月31日期间的不一致X光片进行前瞻性队列研究。在此期间，放射科医生将2083张X光片分类为一致或不一致。349张被分类为不一致，其中324张符合研究条件。查阅病历以获取相关体格检查结果和急诊科的处理情况。影响患者治疗的差异被视为具有临床意义。
在2083张X光片中，有23张（1.1%）急诊医生和放射科医生的解读不同，这种不同可能改变患者的治疗方案。这占放射科医生最初分类为不一致X光片的7%（23/324）。最常见的差异是胸部检查正常的患者，但急诊医生将X光片解读为有浸润，而放射科医生随后解读为无浸润（12/324）。这些患者可能接受了不必要的抗生素治疗。有两种差异解读若未被发现可能对患者产生严重后果。一名心脏扩大的患者和另一名腹部X光片显示有游离气体的患者，急诊医生未注意到。
急诊医生若能更严格地解读胸部X光片，避免不必要的抗生素治疗，将从中受益。急诊医生在解读普通X光片方面做得很好，但偶尔会遗漏可能导致不良后果的重要发现。放射科医生每天24小时随时解读X光片可防止漏诊，但鉴于严重误读的数量较少，可能不具有成本效益。
