Kim Na Young, Kim Ji Hoon, Suh Young Joo
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Department of Emergency Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
BMC Med Imaging. 2025 Jul 1;25(1):246. doi: 10.1186/s12880-025-01781-3.
Discrepancies between preliminary reports by on-call radiology residents and final reports of coronary computed tomography angiography (CCTA) in the emergency department (ED) have not been thoroughly investigated.
We conducted a retrospective quality assurance analysis of CCTA examinations performed during off-hours in a level-1 ED at a tertiary teaching hospital between March 2020 and April 2022. Discrepancies in identifying significant coronary artery disease (≥ 50% stenosis) between preliminary reports by on-call residents and final reports by board-certified cardiac radiologists were evaluated.
Among the 766 patient visits (median age, 59 years [interquartile range, 47-70]; 415 men), 82 cases (10.7%) showed discrepancies. Univariable logistic regression analyses identified HEART score, day of ED visit, ED crowding index, and coronary artery calcium (CAC) score as significant factors associated with discrepancies. Multivariable analysis revealed that an ED crowding index < 40 (adjusted odds ratio = 2.06; P = 0.005), and positive CAC scores were independently associated with increased discrepancies (adjusted odds ratio = 4.56 for scores > 0 and ≤ 100, P < 0.001; 4.79 for scores > 100 and ≤ 400, P < 0.001; 3.69 for scores > 400, P = 0.002). The rate of unnecessary invasive coronary angiography was significantly higher in the discrepancy group (80.0%, 12 of 15) compared to the agreement group (14.4%, 16 of 111) (P < 0.05).
A substantial discrepancy rate was observed between preliminary and final CCTA interpretations in the ED. A lower ED crowding index and positive CAC scores were independently associated with an increased risk of discrepancies.
急诊科（ED）中放射科住院医师的初步报告与冠状动脉计算机断层扫描血管造影（CCTA）最终报告之间的差异尚未得到充分研究。
我们对2020年3月至2022年4月期间在一家三级教学医院的一级急诊科非工作时间进行的CCTA检查进行了回顾性质量保证分析。评估了值班住院医师的初步报告与经董事会认证的心脏放射科医生的最终报告在识别显著冠状动脉疾病（≥50%狭窄）方面的差异。
在766例患者就诊中（中位年龄59岁[四分位间距，47 - 70岁]；415名男性），82例（10.7%）存在差异。单变量逻辑回归分析确定HEART评分、急诊就诊日、急诊拥挤指数和冠状动脉钙化（CAC）评分是与差异相关的显著因素。多变量分析显示，急诊拥挤指数<40（调整后的优势比=2.06；P = 0.005）以及阳性CAC评分与差异增加独立相关（评分>0且≤100时调整后的优势比=4.56，P<0.001；评分>100且≤400时为4.79，P<0.001；评分>400时为3.69，P = 0.002）。差异组中不必要的有创冠状动脉造影率（80.0%，15例中的12例）显著高于一致组（14.4%，111例中的16例）（P<0.05）。
在急诊科，CCTA初步解读与最终解读之间存在相当高的差异率。较低的急诊拥挤指数和阳性CAC评分与差异风险增加独立相关。
