ORIGINAL ARTICLE What is the effect of reporting all emergency department radiographs?

Objectives: To evaluate the effect of formal radiological reporting of all emergency department (ED) radiographs on clinical practice and patient outcome, and to consider whether a selective reporting policy might prove safe and effective. Methods: All radiographs taken in a single ED over a six month period were prospectively studied simultaneously in both the emergency and radiology departments to detect cases where a radiograph that was considered normal by ED staff was then reported as abnormal by the reporting radiologist. Whenever such a discrepancy occurred the patient’s records were scrutinised to ascertain the source of the discrepancy, with a gold standard interpretation derived from senior clinical review and addi-tional investigations where indicated. The clinical impact of the radiologist’s formal report was then assessed. Accuracy of interpretation was considered in relation to the grade of ED staff and the radio-graphic examination obtained. Results: During the study period, 19 468 new patient attendances to the ED generated 11 749 radio-graphic examinations. Discrepancies were detected in 175 patients (1.5 % of all radiographic exami-nations). Of these, 136 (1.2%) were subsequently shown to have been incorrectly interpreted in the ED (ED false negatives), with 40 patients (0.3%) undergoing a change in management as a result. In th