Division of Pediatric Critical Care and Pulmonary Medicine, Georgetown University Children's Medical Center, Washington, DC 20007, USA.
J Crit Care. 2010 Jun;25(2):179-83. doi: 10.1016/j.jcrc.2009.05.016. Epub 2009 Aug 13.
When radiologists are not available, chest radiographs (CXRs) of pediatric intensive care unit (PICU) patients are commonly interpreted by pediatric intensivists. We prospectively investigated the frequency of errors in CXR interpretation by pediatric intensivists and their impact on patient management.
Chest radiographs of PICU patients were evaluated by 5 pediatric intensivists then by a pediatric radiologist (the "gold standard"). If the interpretation of the radiologist and intensivist differed, an independent intensivist determined whether a management change took place. A pediatric pulmonologist determined how many intensivist interpretations were different from the radiologist's interpretations.
Seven hundred twenty-eight radiographic findings were identified by the radiologist in 460 CXRs. There were 33 interpretation errors by the intensivists (4.5% of the findings in 7.1% of the CXRs). Only 3/33 error corrections (0.45% of the findings in 0.7% of the CXRs) resulted in change in patient management.
Errors in interpretation of CXRs by pediatric intensivists were common but less than that in other series, probably because of education of the pediatric intensivists through daily rounds with the radiologist. Although interpretation errors that affected patient management were rare, their clinical importance supports the growing practice of 24/7 remote radiograph reading by radiologists.
当放射科医生无法提供服务时，儿科重症监护病房（PICU）患者的胸部 X 光片（CXR）通常由儿科重症监护医生进行解读。我们前瞻性地研究了儿科重症监护医生在 CXR 解读中出现错误的频率及其对患者管理的影响。
由 5 名儿科重症监护医生评估 PICU 患者的胸部 X 光片，然后由一名儿科放射科医生（“金标准”）进行评估。如果放射科医生和重症监护医生的解读结果不同，则由另一名独立的重症监护医生确定是否进行管理变更。一名儿科肺科医生确定了有多少重症监护医生的解读结果与放射科医生的解读结果不同。
放射科医生在 460 张 CXR 中发现了 728 种放射学表现。重症监护医生的解读存在 33 个错误（占 CXR 中 7.1%的发现的 4.5%）。只有 3/33 的纠错结果（占 CXR 中 0.7%的发现的 0.45%）导致患者管理的改变。
儿科重症监护医生在解读 CXR 方面的错误很常见，但少于其他系列研究，这可能是因为儿科重症监护医生通过与放射科医生的日常查房接受了教育。尽管影响患者管理的解读错误很少见，但它们的临床重要性支持放射科医生进行 24/7 远程 X 光片阅读的做法日益普及。
