Lal N R, Murray U M, Eldevik O P, Desmond J S
Department of Radiology, University of Michigan Medical Center, Ann Arbor, USA.
AJNR Am J Neuroradiol. 2000 Jan;21(1):124-9.
Studies have looked at the accuracy of radiologic interpretations by radiology residents as compared with staff radiologists with regard to emergency room plain films, emergency room body CT scans, and trauma head CT scans; however, to our knowledge, no study has evaluated on-call resident interpretations of all types of neuroradiologic CT scans. Both as a part of our departmental quality control program and to address concerns of clinical services about misinterpretation of neuroradiologic CT scans by on-call radiology residents, we evaluated the frequency of incorrect preliminary interpretations of neuroradiologic CT scans by on-call radiology residents and the effect of such misinterpretations on clinical management and patient outcome.
As determined by the staff neuroradiologist the next day, all potentially clinically significant changes to preliminary reports of emergency neuroradiologic CT scans rendered by on-call radiology residents were recorded over a 9-month period. A panel of neuroradiologists reviewed and graded all the changed cases by consensus. An emergency department staff physician reviewed medical records of all submitted cases to determine clinical consequences of the misinterpretations.
Significant misinterpretations were made in 21 (0.9%) of 2388 cases during the study period. There was a significant change in patient management in 12 of the cases, with a potentially serious change in patient outcome in two cases (0.08%).
On-call radiology residents have a low rate of significant misinterpretations of neuroradiologic CT scans, and the potential to affect patient outcome is rare.
已有研究比较了放射科住院医师与放射科 staff 医师对急诊平片、急诊身体 CT 扫描及创伤性头部 CT 扫描的影像学解读准确性；然而，据我们所知，尚无研究评估放射科住院医师对各类神经放射学 CT 扫描的值班解读情况。作为我们科室质量控制计划的一部分，同时也是为了解决临床服务部门对放射科值班住院医师对神经放射学 CT 扫描解读错误的担忧，我们评估了放射科值班住院医师对神经放射学 CT 扫描初步解读错误的频率，以及此类错误解读对临床管理和患者预后的影响。
由次日的神经放射科 staff 医师确定，在 9 个月的时间里，记录了放射科值班住院医师对急诊神经放射学 CT 扫描初步报告中所有潜在具有临床意义的变化。一组神经放射科医师通过共识对所有更改的病例进行审查和分级。一名急诊科 staff 医师审查了所有提交病例的病历，以确定错误解读的临床后果。
在研究期间的 2388 例病例中，有 21 例（0.9%）出现了重大错误解读。其中 12 例患者的管理发生了重大变化，2 例患者的预后出现了潜在的严重变化（0.08%）。
放射科值班住院医师对神经放射学 CT 扫描的重大错误解读率较低，影响患者预后的可能性也很小。
