Adverse Events from Emergency Physician Pediatric Extremity Radiograph Interpretations: A Prospective Cohort Study
| العنوان: | Adverse Events from Emergency Physician Pediatric Extremity Radiograph Interpretations: A Prospective Cohort Study |
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| المؤلفون: | Trent Mizzi, Kathy Boutis, Jyoti Panwar, Mark W Camp, Soni Prasad, Arash Khosroawshahi, Jennifer Stimec, Adam I. Kramer, Keith Colaco, Faisal Al-Sani |
| المصدر: | Academic Emergency Medicine. 27:128-138 |
| بيانات النشر: | Wiley, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Male, Pediatrics, medicine.medical_specialty, Adolescent, Fractures, Bone, Health care, Odds Ratio, medicine, Humans, Prospective Studies, Diagnostic Errors, Child, Adverse effect, Prospective cohort study, Pediatric Emergency Medicine, business.industry, Medical record, Extremities, General Medicine, Odds ratio, Emergency department, Confidence interval, Radiography, Pre- and post-test probability, Child, Preschool, Emergency Medicine, Female, Emergency Service, Hospital, business |
| الوصف: | Objectives We determined how often emergency physician pediatric musculoskeletal (MSK) radiograph interpretations were discordant to that of a radiologist and led to an adverse event (AE). We also established the variables independently associated with this outcome. Methods This prospective cohort study was conducted in an urban, tertiary care children's emergency department (ED). We enrolled children who presented to an ED with an extremity injury and received radiographs. ED physicians documented their radiograph interpretation, which was compared to a radiology reference standard. Patients received telephone follow-up and had institutional medical records reviewed in 3 weeks. An AE occurred if there were clinical sequelae and/or repeat health care visits due to a delay in correct radiograph interpretation. Results We enrolled 2,302 children (mean [±SD] age = 9.0 [4.4] years; 1,288 (56.0%) male]. Of these, 180 (7.8%; 95% confidence interval = 6.8 to 9.0) ED physician discordant interpretations resulted in an AE. Specifically, there were no negative clinical outcomes; however, relative to cases diagnosed correctly at the index ED, patients whose fracture was not initially identified encountered 77.2% more subsequent ED visits, while those falsely diagnosed with a fracture experienced 41.5% additional orthopedic clinic visits. Odds of an ED discrepant interpretation was significantly higher if a physician's pretest probability of a fracture was ≤ 20% versus> 20% (adjusted odds ratio [aOR] = 1.6), patient's pain score was ≤ 2 versus> 2 (aOR = 1.6), and injury was located in a joint versus other location (aOR = 1.7). Conclusions Emergency physician discordant pediatric MSK radiograph interpretations that resulted in an AE occurred with regular frequency in a pediatric ED setting. AEs were primarily an increase in subsequent health care visits. Importantly, a low clinical suspicion for a fracture or injury located in the joint were risk factors for ED physician discordant interpretations. |
| تدمد: | 1553-2712 1069-6563 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::45a5c9e2b1d6da6cdb81bb4c64556453Test https://doi.org/10.1111/acem.13884Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....45a5c9e2b1d6da6cdb81bb4c64556453 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15532712 10696563 |
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