Predictors of diagnostic errors in computed tomography interpretation by emergency physicians leading to changes in clinical management in the emergency department.

IF 1.7 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Emergency Radiology Pub Date : 2025-06-23 DOI:10.1007/s10140-025-02357-y

Naoaki Shibata, Takafumi Yonemitsu, Nozomu Shima, Yuichi Miyake, Tomoya Fukui, Junya Fuchigami, Akira Ikoma, Tetsuo Sonomura, Shigeaki Inoue

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引用次数: 0

Abstract

Purpose: The use of computed tomography (CT) in the emergency department (ED) has been increasing due to its diagnostic value for emergency physicians (EPs). This study aimed to determine the predictors of EP interpretation errors (IEs) on CT scans leading to change in clinical management (IECM) in both endogenous and exogenous ED visits.

Methods: This single-center, retrospective cohort study included patients with consecutive ED visits initially managed by EPs at our institution over 6 months. Patients who did not undergo CT imaging and presented with cardiopulmonary arrest upon arrival were excluded. CT images were interpreted by emergency radiologists immediately after acquisition, and IEs were identified. The primary outcome was IECM, determined by reference to the clinical management decisions made by EPs. A multivariate analysis was performed to determine the independent predictors of IECM.

Results: Among the 2,037 patients, 158 (8%) had IEs, whereas 52 (3%) had IECM. Multisite CT imaging was the strongest independent predictor for both IECM (OR: 2.25, 95% CI: 1.21-4.19, P = 0.011) and IEs (OR: 2.32, 95% CI: 1.61-3.36, P < 0.001). Other predictors of IECM were prolonged ED stay and night-time ED visits as clinical factors. Additional predictors of overall IEs were contrast-enhanced CT and abdominopelvic CT as radiological factors.

Conclusion: Multisite CT imaging, which involve multiple organs and extensive diagnostic information, significantly increases the likelihood of misinterpretation, leading to change in clinical management by EPs.

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急诊医生计算机断层扫描诊断错误导致急诊科临床管理改变的预测因素

目的：计算机断层扫描（CT）在急诊科（ED）的应用越来越多，因为它对急诊医生（EPs）的诊断价值。本研究旨在确定内源性和外源性ED就诊时CT扫描EP解释错误（IEs）导致临床管理改变（IECM）的预测因素。方法：这项单中心、回顾性队列研究纳入了在我院连续就诊6个月以上的患者，这些患者最初是由急诊医生管理的。未接受CT成像且到达时出现心肺骤停的患者被排除在外。CT图像在采集后立即由急诊放射科医生进行解读，并确定病灶。主要结局是IECM，由EPs的临床管理决策决定。进行多变量分析以确定IECM的独立预测因子。结果：在2037例患者中，158例（8%）有IEs， 52例（3%）有IECM。多部位CT成像是IECM （OR: 2.25, 95% CI: 1.21-4.19, P = 0.011）和IEs （OR: 2.32, 95% CI: 1.61-3.36， P）最重要的独立预测因子。结论：多部位CT成像涉及多器官和广泛的诊断信息，显著增加误解的可能性，导致EPs临床管理的改变。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Emergency Radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

4.60

自引率

4.50%

发文量

期刊介绍： To advance and improve the radiologic aspects of emergency careTo establish Emergency Radiology as an area of special interest in the field of diagnostic imagingTo improve methods of education in Emergency RadiologyTo provide, through formal meetings, a mechanism for presentation of scientific papers on various aspects of Emergency Radiology and continuing educationTo promote research in Emergency Radiology by clinical and basic science investigators, including residents and other traineesTo act as the resource body on Emergency Radiology for those interested in emergency patient care Members of the American Society of Emergency Radiology (ASER) receive the Emergency Radiology journal as a benefit of membership!