O1024: PEMRRADS: Pediatric Emergency Medicine Radiology Reads, A Descriptive Study

Background: While pediatric emergency medicine (PEM) physicians are reported to be accurate in their independent interpretation of x-rays, little is known about PEM physician confidence in being tasked with interpretation of x-rays and how that confidence compares to their accuracy. At our study site, a large, academic pediatric emergency department serving over 100,000 patients per year, PEM physicians are tasked with independently interpreting x-rays overnight that are overread by a pediatric radiologist in the morning. Discrepant radiology reads are evaluated via a callback system. This study aims to compare the proportion of discrepant reads in various categories of x-rays to a needs assessment evaluating physician confidence in interpreting the same types of films.

Methods: We evaluated discrepant radiology reads from 09/2022 to 02/2024. Discrepant reads were categorized as medical or orthopedic (by body area), a 95% confidence interval was performed for each category, and patient charts for each overread were assessed for patient outcome. Potential outcomes included no change in management, change in management requiring outpatient intervention, or change in management requiring inpatient intervention In addition, a survey-based needs assessment was distributed to PEM attendings and fellows in the same department to evaluate their overall confidence in their ability to independently interpret x-rays, their confidence in their training to do so, and their confidence interpreting various types of films. Survey results were compared with proportions of discrepant radiology reads by category.

Results: During the study period, 8641 x-rays were independently interpreted by PEM physicians. 82 (2.1%, CI = 1.81 - 2.43) x-rays were overread as discrepant by pediatric radiology, with 37.9% of those requiring a change in management. All cases with a change in management required only outpatient interventions. The largest proportion of discrepant reads were found in wrist/hand/finger (3.31%, CI 2.03 - 5.01%), ankle/foot/toe (4.28%, CI 2.73%-6.36%), and chest x-rays (2.43%, CI 1.97%-2.97%). In reviewing the results of the needs assessment, 84% of PEM physicians and fellows were “somewhat confident” or “very confident” in independently interpreting x-rays and 96% agreed or strongly agreed that they felt well prepared by their training to do so. Interestingly, 72% of providers felt “very confident” in their ability to interpret chest x-rays, one of the categories of x-rays with the highest proportion of discrepancies.

Conclusion: PEM physicians are confident in their training and ability to independently interpret x-rays. However, our findings suggest a gap between confidence and accuracy in x-ray interpretation. While the cause of this gap is multifaceted, one potential solution is targeted training interventions. Future efforts should focus on structured education in areas with the highest overread discrepancy rates to improve diagnostic accuracy and patient outcomes.