Missed or misinterpreted neuroradiologic findings by trainees at an academic medical center

1. Residents had a higher percentage of missed or misinterpreted neuroradiologic findings than fellows at a single academic center, suggesting areas for curricular improvement to reduce error rates and improve patient care.

2. Residents missed hydrocephalus, intracranial pressure or edema, new hemorrhage and new infarction more frequently than fellows, while the most common critical discrepancies, overall, included congenital variation, infection, misplaced hardware, new mass and vascular abnormalities.

Evidence Rating: 3 (Average)

Study Rundown: Resident education can be enhanced by gathering and identifying missed or misinterpreted findings as potential areas for focused teaching or curricular improvement. In a single center study, a total of 225 628 neuroradiology examinations were identified over a 3-year period, with 978 modified reports flagged to indicate an addendum that identifying a significant discrepancy between the trainee and attending radiologist interpretations. Of these modified reports, there were a total of 725 missed critical findings (CF), with an overall trainee CF miss rate of 6% (95% CI 5.6-6.4%). The five most frequently missed CF’s were congenital variation, infection, misplaced hardware, a new or enlarging mass, and vascular abnormality. This study aimed to identify specific areas of curricular weakness in radiologic training and introduce a metholodogy by which other institutions may assess their own site specific misses and identify areas of improvement. This study was limited in that it only included a retrospective review of reports that had been electronically flagged, which was not uniformly performed amongst all attending neuroradiologists. Future studies may benefit from provision of an intervention, such as a focused curriculum on the five most frequent misses, to determine if it can adequately address the initial errors identified.

Click to read the study in American Journal of Radiology

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In-Depth [case series]: A critical finding was defined by the neuroradiology department at a single academic medical center that would alter patient management and might require immediate intervention. Only studies that were identified with an electronic flag were evaluated for comparison. It is possible that other cases where critical findings were missed were not electronically flagged, and were not added to the evaluation. Of the 7225 missed CFs, 306 (42.2%) were from MRI scans, and 419 (57.8%) were from CT scans. Of the 324 reports with CFs missed by residents, 43 (13.3%) were missed by first year residents, 139 (42.9%) by second year residents, 83 (25.6%) by third-year residents, and 59 (18.2%) by fourth-year residents. The overall miss rate for residents was 8.6% (95%CI 7.7-9.6%) and for fellows it was 4.8% (95%CI, 4.4-5.3%). When comparing miss rates amongst trainee levels, residents missed new hemorrhage (p < 0.001), new infarction (p < 0.001), and intracranial pressure (p = 0.0033) more frequently than fellows. There were no other statistically significant differences.

Image: PD

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