Fractures and liver lesions top list of residents' ER misses

Researchers used a customized search engine to quickly find that most discordant resident versus attending physician preliminary reports involved fractures, liver/kidney lesions, pulmonary nodules, and gastrointestinal wall thickening.

"To avoid future misses, residents need to know what they are missing. Attending physicians want to know which areas deserve a second glance, while program directors want to know how to adapt curricula for future learning," said lead author Dr. Dean McNaughton, a radiologist from the University of Iowa, in a scientific poster.

The study focused on 33,000 CT, MRI, ultrasound, and nuclear medicine exams in the emergency room during 2006-2007. The authors analyzed matches generated by the automated search for the keywords "not include" contained in the "report disagree" template, giving them 336 misses.

A missed finding was associated with one or more other abnormal findings in 185 of the 336 misses (55%). Fractures-mostly involving facial bones, transverse processes, or ribs-accounted for 59 misses (18%). Other common misses were hypo- or hyperdense lesions (26), usually in the liver or kidney; pulmonary nodules (20); and gastrointestinal wall thickening or fat stranding (15).