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Evaluation of Head CT Exams - Resident & Attending Diagnoses

Evaluation of Head CT Exams - Resident & Attending Diagnoses. Elizabeth Krupinski, PhD William Berger, MD William Erly, MD University of Arizona. Rationale. Many medical centers offer 24-hour CT interpretation for the ED On-call system Teleradiology

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Evaluation of Head CT Exams - Resident & Attending Diagnoses

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  1. Evaluation of Head CT Exams - Resident & Attending Diagnoses Elizabeth Krupinski, PhD William Berger, MD William Erly, MD University of Arizona

  2. Rationale • Many medical centers offer 24-hour CT interpretation for the ED • On-call system • Teleradiology • Radiology residents often provide preliminary interpretations

  3. Rationale • Previous reports indicate overall resident miss rates are low (< 2%) • No one has looked at differences between upper & lower level residents • Assessing the types of errors made by residents may help focus educational efforts

  4. Methods • 1324 consecutive CT head exams ordered by ED • Initially interpreted by 1 of18 radiology residents • Interpretation • Confidence rating on 6-point scale • 1 of 5 CAQ neuroradiologists interpreted exams same day or next morning • Determined correlation of diagnoses

  5. Correlation of Interpretations • Agree • Disagree - Insignificant • No potential for adverse patient outcome • Failure to identify ischemic white matter degeneration • There was no error in synthesis

  6. Correlation of Interpretations • Disagree - Significant • Potential for adverse patient outcome • Mistaking cytoxic edema of metestatic disease for ischemic change • Gross error in synthesis without adverse outcome potential • Mistaking dysgenesis of the corpus callosum for chronic hydrocephalus

  7. Diagnostic Correlation

  8. Disagreement Cases X2 = 44.46, df = 2, p = 0.0001

  9. Year of Residency X2 = 13.80, df = 6, p = 0.032

  10. Resident Confidence X2 = 37.55, df = 4, p = 0.0001

  11. Year of Residency F = 92.01, p = 0.0001

  12. Confidence & Cases X2 = 74.56, df = 2, p = 0.0001

  13. Disagree - Insignificant • 42 False Negatives • Chronic ischemic foci • Fractures • Atrophy • 17 False Positives • Intracranial hemorrhage • Fractures

  14. Disagree - Significant • 14 False Negative • Fractures • Acute right occipital infarct • Temporal lobe contusion • Chronic cortical infarct • Clius mass • Small thalamic hemorrhage

  15. Disagree - Significant • 3 Misinterpretation • Metastatic disease as ischemic focus • Tumor as infarct • Chiari II malformation with callosal dysgenesis as hygroma-hydrocephalus-mass effect • 2 False Positive • Cerebellar Hemorrhage • Cerebral contusion

  16. Conclusions • Resident error is low (< 2%) • Rate of potential change in patient outcome due to resident misinterpretation is low (0.05%) • Year of residency affects performance & confidence

  17. Conclusions • When resident confidence is low, immediate consultation with neuroradiologist is advisable • Efforts to reduce resident errors should focus on ensuring that all bone window images are reviewed and on the signs of cytoxic versus vasogenic edema

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