Patterns of diagnostic error in trauma abdominal CT.

Abstract

To define patterns of diagnostic error in the interpretation of trauma abdominal CT. Two hundred fifty-four out of 1751 abdominal CT scans performed for evaluation of trauma had a definite or equivocal diagnosis of an abdominal injury. Cases were re-read initially without reference to the original reports, in which 44 potential diagnostic errors were identified. A panel of two or three expert readers reviewed each of the 44 cases along with the original report to evaluate the diagnostic error and to search for patterns among the errors. Thirty-one of the 254 CT scans (12%) that were re-read contained non-trivial mistakes that could affect patient outcome. Seventeen were false negative and 14 were false positive. Diagnostic errors were found in the liver, spleen, kidney, retroperitoneum, and peritoneal cavity. Patterns of false-negative diagnosis included missed vascular contrast extravasation, missed hemoperitoneum, and missed right retroperitoneal hematoma. Patterns of false-positive diagnosis included: periportal edema or blood tracking, called a liver laceration; respiratory motion, called a splenic or renal injury; and linear or round lucencies in the spleen or liver, called a laceration. Diagnostic errors in interpreting trauma abdominal CT cluster in several recurring patterns. Awareness of these patterns may assist readers in avoiding future errors.