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Aim: To assess the impact and cost effectiveness of a system of radiological review of accident and emergency (A&E) plain films. Materials and methods: Review documentation was studied retrospectively over a 1-year period. Six hundred and eighty-four actual or suspected errors in the initial radiological interpretation by A&E staff were highlighted by radiologists in training. These selected 'red reports' were then further reviewed by a musculoskeletal radiologist and a more senior member of the A&E team. Results: Three hundred and fifty-one missed or strongly suspected fractures were detected, with ankle, finger and elbow lesions predominating. Other errors included 11 missed chest radiograph abnormalities and 24 A&E false-positives. Radiologists in training tended to over-report abnormalities with an 18% false-positive rate when compared to the subsequent musculoskeletal radiology opinion. Following review, further action was taken by A&E staff in 286 (42.6%) of cases. No operative intervention was required in those patients with a delayed or missed A&E diagnosis. Consideration is given to the cost of providing this form of review and the impact of medico-legal factors. Conclusion: Compared with the large numbers of patients seen and radiographed in a busy A&E department, the number of radiological errors was small. There were even fewer changes in management. Despite this, concern over litigation, clinical governance and future work patterns in A&E make this form of review a useful means of risk reduction in a teaching hospital. © 2000 The Royal College of Radiologists.

Original publication




Journal article


Clinical Radiology

Publication Date





861 - 865