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. 2025 Aug;32(4):513-522.
doi: 10.1007/s10140-025-02357-y. Epub 2025 Jun 23.

Predictors of diagnostic errors in computed tomography interpretation by emergency physicians leading to changes in clinical management in the emergency department

Naoaki Shibata  1 , Takafumi Yonemitsu  2 , Nozomu Shima  1 , Yuichi Miyake  1 , Tomoya Fukui  1 , Junya Fuchigami  1 , Akira Ikoma  3 , Tetsuo Sonomura  3 , Shigeaki Inoue  1
Affiliations

Predictors of diagnostic errors in computed tomography interpretation by emergency physicians leading to changes in clinical management in the emergency department

Naoaki Shibata et al. Emerg Radiol. 2025 Aug.

Abstract

Purpose: The use of computed tomography (CT) in the emergency department (ED) has been increasing due to its diagnostic value for emergency physicians (EPs). This study aimed to determine the predictors of EP interpretation errors (IEs) on CT scans leading to change in clinical management (IECM) in both endogenous and exogenous ED visits.

Methods: This single-center, retrospective cohort study included patients with consecutive ED visits initially managed by EPs at our institution over 6 months. Patients who did not undergo CT imaging and presented with cardiopulmonary arrest upon arrival were excluded. CT images were interpreted by emergency radiologists immediately after acquisition, and IEs were identified. The primary outcome was IECM, determined by reference to the clinical management decisions made by EPs. A multivariate analysis was performed to determine the independent predictors of IECM.

Results: Among the 2,037 patients, 158 (8%) had IEs, whereas 52 (3%) had IECM. Multisite CT imaging was the strongest independent predictor for both IECM (OR: 2.25, 95% CI: 1.21-4.19, P = 0.011) and IEs (OR: 2.32, 95% CI: 1.61-3.36, P < 0.001). Other predictors of IECM were prolonged ED stay and night-time ED visits as clinical factors. Additional predictors of overall IEs were contrast-enhanced CT and abdominopelvic CT as radiological factors.

Conclusion: Multisite CT imaging, which involve multiple organs and extensive diagnostic information, significantly increases the likelihood of misinterpretation, leading to change in clinical management by EPs.

Keywords: Computed tomography; Emergency department; Emergency physician; Radiological misinterpretation; Radiologist.

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Conflict of interest statement

Declarations. Compliance with ethical standards: This study was approved by Research Ethics Committee of Wakayama Medical University (approval number: 1782). The requirement for informed consent was waived due to the retrospective nature of the study. Competing interests: The authors declare that they have no conflict of interest relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Flowchart of the study process. ED: emergency department, CT: computed tomography, CPAOA: cardiopulmonary arrest on arrival, IE: interpretation error, IECM: interpretation error leading to change in clinical management
Fig. 2
Fig. 2
Distribution of interpretation outcomes by reason for ED visit. ED: emergency department, IE: interpretation error, IECM: interpretation error leading to change in clinical management. *Percentages above the top segment represent the IECM rate within each category
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