• Liza Gergenti and Robert P Olympia.
• Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA. Electronic address: lgergenti@pennstatehealth.psu.edu.
• Am J Emerg Med. 2019 Nov 1; 37 (11): 2015-2019.

BackgroundDiagnostic errors made by radiology resident physicians may lead to significant morbidity/mortality and patient dissatisfaction.ObjectiveTo determine the etiology and disposition associated with radiology discrepancies on emergency department (ED) patients.MethodsWe conducted a retrospective electronic chart review of patients presenting to our ED during "off hours" at the Penn State Hershey Medical Center during October 2013-November 2014 and had a radiology discrepancy, defined as a patient discharged from the ED with a diagnostic interpretation disagreement between the initial radiology resident physician read and final radiology attending physician read.Results81,201 images were performed during "off hours", with 174 radiology discrepancies (0.214%) identified. Most discrepancies were associated with CT scans (62%). The most common final diagnostic interpretations associated with discrepancies were missed fracture (10.9%), incidental findings of mass or cyst (10.3%), gastrointestinal inflammation (6.3%), and pneumonia (5.7%). 10% of radiology discrepancies were instructed to emergently return to the ED. The most common modality associated with ED follow-up was CT scan of the abdomen/pelvis (50%). Of the 17 patients that returned to the ED, 10 had additional diagnostic imaging, 9 received a subspecialist consult, 5 required surgical treatment, 5 required additional medications, and 1 required a medical hospitalization.ConclusionsBased on our sample, discrepancies were a small percentage of images performed during "off hours", and were associated with CT scans, missed fractures, and non-emergent outpatient follow-up. We suggest that ED and radiology departments work collaboratively to monitor their own rates of discrepancies, and subsequent morbidities and mortalities, to improve patient care.Copyright © 2019 Elsevier Inc. All rights reserved.

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