The radiograph factors that caused diagnostic Error in Anatomy interpretation difficulties for emergency doctors (EPs) assessing Pediatric musculoskeletal (pMSK) radiographs were identified. EPs used a web-based platform to interpret 1,850 pMSK radiographs, and researchers used a 1-parameter item response theory to calculate interpretation difficulty scores for each radiograph in 13 body areas. They evaluated the difficulty scores by fracture presence or absence and fracture site and morphology, if appropriate; significance was adjusted for multiple comparisons. An expert panel looked at the 65 most common fracture-negative radiographs to see what imaging features were mistaken for fractures. Investigators used data from 244 EPs to generate 185,653 different interpretations. Those without a fracture had greater interpretation difficulty scores on the elbow, forearm, wrist, femur, knee, and tibia-fibula radiographs than those with a fracture; the opposite was true for hand, pelvic, foot, and ankle radiographs (p<0.004 for all comparisons). According to the descriptive review, specific normal architecture, overlapping bones, and external artifacts from muscle or skin folds were frequently mistaken for fractures. The anatomic position of the fracture in the elbow, pelvis, and ankle had a significant difference in difficulty score (p<0.004 for all comparisons). The growth plate of the ankle and elbow and fibular avulsion and humerus condylar fractures were more difficult to detect than other fracture patterns (p<0.004 for all comparisons). In pMSK radiograph interpretation for EPs, study group discovered meaningful learning opportunities.
Source:www.jem-journal.com/article/S0736-4679(21)01064-7/fulltext
