Accuracy of interpretations of emergency department radiographs: effect of confidence levels

Ann Emerg Med. 1989 Aug;18(8):826-30. doi: 10.1016/s0196-0644(89)80205-7.


We conducted a prospective study to assess the relationship between the interpretive agreement rate for emergency department radiographs and the degree of interpretive confidence. We hoped to identify a subset of ED radiographs that did not require mandatory review by a radiologist. For each of the 1,872 plain radiographs studied, emergency physicians assigned a confidence level to the interpretation before comparing it with the radiologist's dictated report. A second radiologist was consulted to resolve disagreements. The overall rate of interpretive agreement was 94.6%. Agreement varied significantly (P less than .001) as a function of confidence level and by type of radiograph, but not by training level. Agreement varied significantly (P less than .001) as a function of confidence level for some types of radiographs (eg, chest, extremities) and for some types of radiographic findings (acute positive). No subset of radiographs had 100% agreement. Treatment was potentially altered in 38 patients as a result of the interpretive disagreement that occurred in 2% of studied radiographs. We conclude that the interpretive agreement rate increases in relation to interpretive confidence but that confidence levels cannot safely exclude certain radiographs from mandatory review by a radiologist.

Publication types

  • Review

MeSH terms

  • Emergency Medicine*
  • Emergency Service, Hospital*
  • Extremities / diagnostic imaging
  • Humans
  • Interprofessional Relations
  • Prospective Studies
  • Radiography*
  • Radiography, Abdominal
  • Radiography, Thoracic
  • Radiology*
  • Skull / diagnostic imaging
  • Spine / diagnostic imaging