E4795. Simulated On-Call Radiology: Assessing Resident Errors in Neurologic Trauma Cases
  1. Isabella Amador; University of Florida College of Medicine
  2. Abheek Raviprasad; University of Florida College of Medicine
  3. Kevin Pierre; University of Florida College of Medicine
  4. Christopher Sistrom; University of Florida College of Medicine
  5. Priya Sharma; University of Florida College of Medicine
  6. Anthony Mancuso; University of Florida College of Medicine
  7. Dhanashree Rajderkar; University of Florida College of Medicine
Independent radiology call is a key formative residency experience, where residents are expected to independently review emergency imaging studies that present during an evening or overnight shift. The highest frequency of trauma admissions has been found to occur after 7 pm, emphasizing the importance of preparing residents to read such cases. Our study aims to evaluate radiology residents' proficiency in identifying three specific neurologic trauma cases using radiographic imaging in a simulated call-shift scenario.

Materials and Methods:
The Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM) is a tested and reliable computer-aided emergency imaging simulation that was employed to assess resident readiness for independent radiology call. The simulation included 65 cases of varying complexity, including normal studies, with at least one case specifically targeting identification of a neurologic trauma case. Residents' free text responses were manually scored by faculty members using a standardized grading rubric, with errors subsequently classified by type.

Craniocervical fracture, vertebral artery dissection, and temporal CSF leak were identified as three commonly missed neurologic trauma cases. In an 8-hour simulated on-call shift, 328 radiology residents encountered noncontrast CT images of pediatric craniocervical fracture. Craniocervical fracture was consistently underdiagnosed, with a median score of 2/10 and an average score of 2.31/10. On average, 7.66 points out of 10 were lost due to observational errors (unrecognized imaging findings), while 0.00 points were lost to interpretive errors (misdiagnosis or incorrect staging). Only 13% of residents generated effective reports (grades A & B, scoring between 7 and 10), while a striking 75% produced reports with critical errors (grades F & D, scoring between 0 and 2). A subsequent simulation with 99 residents featuring a case of vertebral artery dissection on MRI revealed similar challenges, with 15% of residents producing effective quality reports and 53% producing reports with critical errors. The average score was 3.01, with 6.97 points lost due to observational error. The third simulation involved 316 residents, who encountered a case of temporal CSF leak on MRI. The median score was 2, and the average score was 3.16; 52% produced reports with critical errors, with only 14% generating effective reports. On average, 6.59 points were lost due to observational error.

Error in all three cases was found to be predominantly due to observational error. Our findings underscore a potential gap in radiology residency training related to the accurate identification of craniocervical fractures, vertebral artery dissections, and CSF leaks, highlighting the potential need for enhanced educational efforts in these areas.