Discrepancies in Radiograph Interpretation Between Pediatric Radiologists and Pediatric Intensivists in the Pediatric or Neonatal Intensive Care Unit

Adam Z. Fink, Terry L. Levin, Einat Blumfield, Sheri L. Nemerofsky, Mark C. Liszewski, Kandi George, Suhas M. Nafday, Mark Shlomovich, K. Allen Eddington, Eliza H. Myers, Henry Michael Ushay

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Abstract

Background: In pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs), patient management decisions are sometimes based on preliminary interpretations of radiographs by pediatric intensivists (PIs) before a formal interpretation by a pediatric radiologist (PRs). Objective: To quantify and classify discrepancies in radiographic interpretation between PRs and PIs in the PICU and NICU. Materials and Methods: This institutional review board-approved multi-institutional prospective study included three PRs and PIs at two PICUs and three NICUs. Interpretations of chest and abdominal radiographs by PIs and PRs were recorded on online forms and compared. Discrepancies in interpretations were classified as "miss," "misinterpretation," or "overcall." The discrepancies were also categorized as "actionable" or "nonactionable" based on extrapolation of the ACR actionable reporting work group's list of actionable findings. Results: In 960 radiographic interpretations, the total, nonactionable, and actionable discrepancy rates between PRs and PIs were 34.7%, 26.8%, and 7.9%, respectively. The most common actionable discrepancies were line or tube positions and identification and interpretation of parenchymal opacities in the lungs. Identification of air leaks in the PICU and differentiation of normal from abnormal bowel gas patterns in the NICU followed in frequency. Air leaks accounted for 1% of total discrepancies and 11% of actionable discrepancies. Most discrepancies were nonactionable and included retrocardiac atelectasis and mischaracterization of neonatal lung disease in the PICU and NICU, respectively. Conclusion: Although the total discrepancy rate was high, most discrepancies were nonactionable. Actionable discrepancies were predominantly due to line and tube position, which should be an area of focused education.

Original languageEnglish (US)
JournalJournal of the American College of Radiology
DOIs
StateAccepted/In press - Jan 1 2018

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Pediatric Intensive Care Units
Neonatal Intensive Care Units
Pediatrics
Infant, Newborn, Diseases
Air
Radiologists
Pulmonary Atelectasis
Research Ethics Committees
Lung Diseases
Thorax
Gases
Prospective Studies
Education
Lung

Keywords

  • Discrepancy
  • NICU
  • Pediatric intensivist
  • Pediatric radiologist
  • PICU
  • Radiograph interpretation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{91650f79d1094ffabde9a8f8eae4d2a6,
title = "Discrepancies in Radiograph Interpretation Between Pediatric Radiologists and Pediatric Intensivists in the Pediatric or Neonatal Intensive Care Unit",
abstract = "Background: In pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs), patient management decisions are sometimes based on preliminary interpretations of radiographs by pediatric intensivists (PIs) before a formal interpretation by a pediatric radiologist (PRs). Objective: To quantify and classify discrepancies in radiographic interpretation between PRs and PIs in the PICU and NICU. Materials and Methods: This institutional review board-approved multi-institutional prospective study included three PRs and PIs at two PICUs and three NICUs. Interpretations of chest and abdominal radiographs by PIs and PRs were recorded on online forms and compared. Discrepancies in interpretations were classified as {"}miss,{"} {"}misinterpretation,{"} or {"}overcall.{"} The discrepancies were also categorized as {"}actionable{"} or {"}nonactionable{"} based on extrapolation of the ACR actionable reporting work group's list of actionable findings. Results: In 960 radiographic interpretations, the total, nonactionable, and actionable discrepancy rates between PRs and PIs were 34.7{\%}, 26.8{\%}, and 7.9{\%}, respectively. The most common actionable discrepancies were line or tube positions and identification and interpretation of parenchymal opacities in the lungs. Identification of air leaks in the PICU and differentiation of normal from abnormal bowel gas patterns in the NICU followed in frequency. Air leaks accounted for 1{\%} of total discrepancies and 11{\%} of actionable discrepancies. Most discrepancies were nonactionable and included retrocardiac atelectasis and mischaracterization of neonatal lung disease in the PICU and NICU, respectively. Conclusion: Although the total discrepancy rate was high, most discrepancies were nonactionable. Actionable discrepancies were predominantly due to line and tube position, which should be an area of focused education.",
keywords = "Discrepancy, NICU, Pediatric intensivist, Pediatric radiologist, PICU, Radiograph interpretation",
author = "Fink, {Adam Z.} and Levin, {Terry L.} and Einat Blumfield and Nemerofsky, {Sheri L.} and Liszewski, {Mark C.} and Kandi George and Nafday, {Suhas M.} and Mark Shlomovich and Eddington, {K. Allen} and Myers, {Eliza H.} and Ushay, {Henry Michael}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jacr.2017.12.007",
language = "English (US)",
journal = "Journal of the American College of Radiology",
issn = "1558-349X",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Discrepancies in Radiograph Interpretation Between Pediatric Radiologists and Pediatric Intensivists in the Pediatric or Neonatal Intensive Care Unit

AU - Fink, Adam Z.

AU - Levin, Terry L.

AU - Blumfield, Einat

AU - Nemerofsky, Sheri L.

AU - Liszewski, Mark C.

AU - George, Kandi

AU - Nafday, Suhas M.

AU - Shlomovich, Mark

AU - Eddington, K. Allen

AU - Myers, Eliza H.

AU - Ushay, Henry Michael

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: In pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs), patient management decisions are sometimes based on preliminary interpretations of radiographs by pediatric intensivists (PIs) before a formal interpretation by a pediatric radiologist (PRs). Objective: To quantify and classify discrepancies in radiographic interpretation between PRs and PIs in the PICU and NICU. Materials and Methods: This institutional review board-approved multi-institutional prospective study included three PRs and PIs at two PICUs and three NICUs. Interpretations of chest and abdominal radiographs by PIs and PRs were recorded on online forms and compared. Discrepancies in interpretations were classified as "miss," "misinterpretation," or "overcall." The discrepancies were also categorized as "actionable" or "nonactionable" based on extrapolation of the ACR actionable reporting work group's list of actionable findings. Results: In 960 radiographic interpretations, the total, nonactionable, and actionable discrepancy rates between PRs and PIs were 34.7%, 26.8%, and 7.9%, respectively. The most common actionable discrepancies were line or tube positions and identification and interpretation of parenchymal opacities in the lungs. Identification of air leaks in the PICU and differentiation of normal from abnormal bowel gas patterns in the NICU followed in frequency. Air leaks accounted for 1% of total discrepancies and 11% of actionable discrepancies. Most discrepancies were nonactionable and included retrocardiac atelectasis and mischaracterization of neonatal lung disease in the PICU and NICU, respectively. Conclusion: Although the total discrepancy rate was high, most discrepancies were nonactionable. Actionable discrepancies were predominantly due to line and tube position, which should be an area of focused education.

AB - Background: In pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs), patient management decisions are sometimes based on preliminary interpretations of radiographs by pediatric intensivists (PIs) before a formal interpretation by a pediatric radiologist (PRs). Objective: To quantify and classify discrepancies in radiographic interpretation between PRs and PIs in the PICU and NICU. Materials and Methods: This institutional review board-approved multi-institutional prospective study included three PRs and PIs at two PICUs and three NICUs. Interpretations of chest and abdominal radiographs by PIs and PRs were recorded on online forms and compared. Discrepancies in interpretations were classified as "miss," "misinterpretation," or "overcall." The discrepancies were also categorized as "actionable" or "nonactionable" based on extrapolation of the ACR actionable reporting work group's list of actionable findings. Results: In 960 radiographic interpretations, the total, nonactionable, and actionable discrepancy rates between PRs and PIs were 34.7%, 26.8%, and 7.9%, respectively. The most common actionable discrepancies were line or tube positions and identification and interpretation of parenchymal opacities in the lungs. Identification of air leaks in the PICU and differentiation of normal from abnormal bowel gas patterns in the NICU followed in frequency. Air leaks accounted for 1% of total discrepancies and 11% of actionable discrepancies. Most discrepancies were nonactionable and included retrocardiac atelectasis and mischaracterization of neonatal lung disease in the PICU and NICU, respectively. Conclusion: Although the total discrepancy rate was high, most discrepancies were nonactionable. Actionable discrepancies were predominantly due to line and tube position, which should be an area of focused education.

KW - Discrepancy

KW - NICU

KW - Pediatric intensivist

KW - Pediatric radiologist

KW - PICU

KW - Radiograph interpretation

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U2 - 10.1016/j.jacr.2017.12.007

DO - 10.1016/j.jacr.2017.12.007

M3 - Article

C2 - 29501502

AN - SCOPUS:85042676476

JO - Journal of the American College of Radiology

JF - Journal of the American College of Radiology

SN - 1558-349X

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