• Jack Kinnersly, Furqan Ahmed, Chris Selman, and Elyssia M Bourke.
• Emergency Department, Grampians Health, Ballarat, Victoria, Australia.
• Emerg Med Australas. 2024 Nov 27.

ObjectivesTo determine the frequency and clinical consequences of discrepancies in skeletal radiograph interpretation between emergency and radiology doctors in an Australian ED.MethodsWe reviewed the records of adult and paediatric patients assessed with skeletal radiography in an ED in Victoria, Australia over 3 months (January to March 2022). Epidemiological data, the interpretation of the radiograph by ED and radiology doctors, and clinical management of the patient were recorded to determine interpretation discrepancies and the consequences of these.ResultsThere were 2359 unique skeletal radiographs in 1576 patient presentations during the study period. Of these, 140 (6%) had a discrepancy. Where a discrepancy existed, 47% of the ED interpretation reported a fracture and/or dislocation which was not present in the radiology interpretation (false positive), whereas the remaining (53%) were attributed to a missed fracture and/or dislocation (false negative). Thirty-five discrepancies (2%) required a change in patient management and were therefore clinically significant. The most commonly affected body region was the elbow, where 15% of radiographs were discrepant. Pathology was more often missed when multiple abnormalities were present on the same radiograph (odds ratio = 4.2, 95% confidence interval = 2.5-6.8).ConclusionThe rate of clinically significant discrepancies in the interpretation of skeletal radiographs by emergency medicine doctors is low. This data support using the ED interpretation of radiographs to guide initial management as safe practice.© 2024 Australasian College for Emergency Medicine.

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