On-call musculoskeletal radiographs: discrepancy rates between radiology residents and musculoskeletal radiologists

The purpose of this study was to determine the rate of discrepancy between radiology residents and attending musculoskeletal radiologists in interpretation of on-call musculoskeletal radiographs. We performed a retrospective review of 2219 consecutive musculoskeletal radiology reports on patients who visited the emergency department between January 2009 and December 2010. The images were initially interpreted overnight by on-call residents (postgraduate years 3-5), and a final interpretation was rendered the next morning by a musculoskeletal radiologist. The reports were evaluated for major discrepancies, such as missed fractures, osteomyelitis, foreign bodies, tumors, and acute arthritic conditions, which were defined as cases in which a change in clinical management was needed and required notification of the emergency care provider. The overall discrepancy rate was 1.8% (40/2219). Fractures accounted for 62.5% (25/40) of missed findings. Fractures involving the upper extremity, particularly the hand and wrist (2.2% [9/405]), were the most frequently missed. Radial fractures accounted for 50% (7/14) of the missed upper extremity fractures. Foreign bodies (10% [4/40]) and tumorlike lesions (7.5% [3/40]) accounted for the next most common misses. Finally, independent resident readings in the on-call setting had little adverse effect on patient care. In the on-call setting, the low discrepancy rate between interpretations of musculoskeletal radiographs by residents and by musculoskeletal attending radiologists is comparable to that reported for other body parts and modalities. Residents should be aware of the relatively high rate of missed pathologic findings in the upper extremity, especially the radius.