Factors Involved in Discrepant Preliminary Radiology Resident Interpretations of Neuroradiological Imaging Studies: A Retrospective Analysis

OBJECTIVE. The purpose of this article is to determine discrepancy rates in radiology residents' interpretations of CT and MRI studies of the head, neck, and spine and to attempt to quantify its potential or realized effect on patient care. Secondarily, we attempted to determine the effect of resident, study, and patient variables on discrepancy rate. MATERIALS AND METHODS. A retrospective review of all relevant studies from March 1, 2009, through December 31, 2009, revealed 5695 cases with preliminary interpretations made by on-call residents. Preliminary and final attending radiologists' reports were compared for concordance, and for all discrepant reports, electronic patient records were investigated for patient impact. Discrepancies were deemed minor or major depending on the presence of a negative impact on care. Variables were investigated for their effect on discrepancy rate by univariate logistic regression analysis, with significant regressors included in subsequent multivariate modeling. RESULTS. The overall discrepancy rate for all included studies was 8.4% (7.2% minor and 1.2% major). Head CT showed the highest concordance (92.6%), whereas MRI studies had discrepancy rates when compared with equivalent CT studies. By multivariate binomial logistic regression, several variables positively correlated with concordance, including resident training level, outpatient status, and concluding hours of call shift. CONCLUSION. The observed rates of discrepancy for all study types were comparable to those in the current literature. Furthermore, a nearly linear downward trend in discrepancy rate with increasing resident training level was found. Similarly, we uniquely showed that discrepancy rate varies with patient status, study indication, and hour of call. These factors should be appropriately considered during evaluation or remediation of radiology residents.