E4796. Orthopedic Trauma Detection in Simulated On-Call Radiology: Highlighting Observational Errors Among Residents
  1. John Ramos Rivas; 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
Radiology residents frequently encounter emergency imaging studies during evening or overnight independent shifts, particularly given that the majority of trauma admissions present after 7 pm. Recognizing this, our study evaluates the ability of radiology residents to accurately identify three specific types of orthopedic trauma using radiographic imaging within a simulated on-call environment.

Materials and Methods:
We utilized the Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM) – a proven computer-aided emergency imaging simulator – to gauge residents' preparedness for independent radiology call. This simulation incorporated 65 diverse cases, among which, at least one centered on orthopedic trauma identification. Faculty members manually graded residents' textual responses using a standardized rubric, and any errors were categorized accordingly.

Sacral ala fracture, femoral neck fracture, and pediatric tibia fracture were identified as the three most commonly missed orthopedic trauma cases. In an 8-hour simulated on-call shift, 321 radiology residents encountered x-ray images of a sacral ala fracture. Despite the years in training, the sacral ala fracture was consistently underdiagnosed, with a median score of 0/10 and an average score of 1.29/10. On average, 8.71 points out of 10 were lost due to observational errors (unrecognized imaging findings), and 0.00 points were lost to interpretive errors (misdiagnosis or incorrect staging). Only 6% of residents generated effective reports (grades A & B, scoring between 7 and 10), and 80% produced reports with critical errors (grades D & F, scoring between 0 and 2). In a subsequent simulation, 316 radiology residents encountered CT images of femoral neck fracture. This simulation revealed similar challenges, with 25% of residents producing effective quality reports and 66% producing reports with critical errors. The average score was 0.25, with 6.71 points lost due to observational error. The third simulation involved 197 residents, who were presented with x-ray images of a pediatric tibia fracture. The median was 0, and the average score was 2.94; 71% produced reports with critical errors, with only 29% generating effective reports. On average, 6.60 points were lost due to observational error.

In all three cases, point deductions were primarily a result of observational error. Our findings identify a potential deficiency in radiology residency programs' training related to the accurate identification of sacral ala fractures, femoral neck fractures, and pediatric tibial fractures, suggesting a need for additional targeted instruction in these areas.