TY - JOUR
T1 - “Concordance” Revisited
T2 - A Multispecialty Appraisal of “Concordant” Preliminary Abdominopelvic CT Reports
AU - Brown, Jordan M.
AU - Dickerson, Elliot C.
AU - Rabinowitz, Lee C.
AU - Cohan, Richard H.
AU - Ellis, James H.
AU - Litell, John M.
AU - Kaza, Ravi K.
AU - Lopez, Alexis N.
AU - Theyyunni, Nikhil R.
AU - Weber, Joseph T.
AU - Kocher, Keith E.
AU - Davenport, Matthew S.
N1 - Publisher Copyright:
© 2016 American College of Radiology
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Purpose To determine whether resident abdominopelvic CT reports considered prospectively concordant with the final interpretation are also considered concordant by other blinded specialists and abdominal radiologists. Methods In this institutional review board–approved retrospective cohort study, 119 randomly selected urgent abdominopelvic CT examinations with a resident preliminary report deemed prospectively “concordant” by the signing faculty were identified. Nine blinded specialists from Emergency Medicine, Internal Medicine, and Abdominal Radiology reviewed the preliminary and final reports and scored the preliminary report with respect to urgent findings as follows: 1.) concordant; 2.) discordant with minor differences; 3.) discordant with major differences that do not alter patient management; or 4.) discordant with major differences that do alter patient management. Predicted management resulting from scores of 4 was recorded. Consensus was defined as majority agreement within a specialty. Consensus major discrepancy rates (ie, scores 3 or 4) were compared to the original major discrepancy rate of 0% (0/119) using the McNemar test. Results Consensus scores of 4 were assigned in 18% (21/119, P < .001, Emergency Medicine), 5% (6/119, P = .03, Internal Medicine), and 13% (16/119, P < .001, Abdominal Radiology) of examinations. Consensus scores of 3 or 4 were assigned in 31% (37/119, P < .001, Emergency Medicine), 14% (17/119, P < .001, Internal Medicine), and 18% (22/119, P < .001, Abdominal Radiology). Predicted management alterations included hospital status (0-4%), medical therapy (1%-4%), imaging (1%-10%), subspecialty consultation (3%-13%), nonsurgical procedure (3%), operation (1%-3%), and other (0-3%). Conclusions The historical low major discrepancy rate for urgent findings between resident and faculty radiologists is likely underreported.
AB - Purpose To determine whether resident abdominopelvic CT reports considered prospectively concordant with the final interpretation are also considered concordant by other blinded specialists and abdominal radiologists. Methods In this institutional review board–approved retrospective cohort study, 119 randomly selected urgent abdominopelvic CT examinations with a resident preliminary report deemed prospectively “concordant” by the signing faculty were identified. Nine blinded specialists from Emergency Medicine, Internal Medicine, and Abdominal Radiology reviewed the preliminary and final reports and scored the preliminary report with respect to urgent findings as follows: 1.) concordant; 2.) discordant with minor differences; 3.) discordant with major differences that do not alter patient management; or 4.) discordant with major differences that do alter patient management. Predicted management resulting from scores of 4 was recorded. Consensus was defined as majority agreement within a specialty. Consensus major discrepancy rates (ie, scores 3 or 4) were compared to the original major discrepancy rate of 0% (0/119) using the McNemar test. Results Consensus scores of 4 were assigned in 18% (21/119, P < .001, Emergency Medicine), 5% (6/119, P = .03, Internal Medicine), and 13% (16/119, P < .001, Abdominal Radiology) of examinations. Consensus scores of 3 or 4 were assigned in 31% (37/119, P < .001, Emergency Medicine), 14% (17/119, P < .001, Internal Medicine), and 18% (22/119, P < .001, Abdominal Radiology). Predicted management alterations included hospital status (0-4%), medical therapy (1%-4%), imaging (1%-10%), subspecialty consultation (3%-13%), nonsurgical procedure (3%), operation (1%-3%), and other (0-3%). Conclusions The historical low major discrepancy rate for urgent findings between resident and faculty radiologists is likely underreported.
KW - Quality assurance
KW - RADPEER
KW - diagnostic error
KW - multidisciplinary
KW - on-call
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U2 - 10.1016/j.jacr.2016.04.019
DO - 10.1016/j.jacr.2016.04.019
M3 - Article
C2 - 27338216
AN - SCOPUS:84991043295
SN - 1546-1440
VL - 13
SP - 1111
EP - 1117
JO - Journal of the American College of Radiology
JF - Journal of the American College of Radiology
IS - 9
ER -