AIMS To identify common errors in ankle X-ray reporting between initial interpretation and final assessment at the virtual fracture clinic. Also, to assess time of initial reporting as a causative factor for discrepancy. METHODS Two thousand nine hundred forty-seven final reports were reviewed by standard of agreement to the initial interpretation. Where discrepancy was found, it was classified and collated by specific finding. Comparison was made between reports with discrepancy and the complete dataset, allowing rates of error by finding to be established. The reports containing discrepancy were further classified by time period, this was compared against an expected value to establish if initial reporting outside of routine working hours was as accurate as that conducted within routine working hours. RESULTS 94.4% of reports were in agreement with the initial interpretation, 2.9% contained minor discrepancy, and 2.7% major discrepancy. In 45.6% of reports there was no radiologically observable injury. 16.4% of reports contained a lateral malleolar fracture, most commonly Weber type B. 40.0% of all navicular fractures, and 33.3% of all cuboidal fractures were not commented upon in the initial reporting. Lower rates of more frequently observed findings were missed with 2.5% of Weber type B fractures not commented upon. An increased proportion of major discrepancy reports were generated from 00:00 to 07:59 (expected = 15.0%, observed = 22.2%; p = 0.07908). Similarly, a greater than expected number of minor discrepancy reports were found between 20:00 and 23:59 (expected = 18.0%, observed = 34.1%, p = 0.00025). CONCLUSIONS The initial reporting of ankle X-rays in the emergency department is performed to a high standard, however serious missed findings emphasise the need for timely senior review. Reporters should increase their awareness of navicular, cuboid, talar, and Weber A fractures which were missed at disproportionate rates. This study also finds evidence to support increased rates of error in initial reporting of ankle X-rays outside of normal working hours (17:00-07:59), particularly with a significantly increased rate of minor discrepancy seen from 20:00 to 23:59.

中文翻译：

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报告在2947年急诊科脚踝X射线中的发现和时间解决的差异。

目的在虚拟骨折诊所中，从最初的解释到最终评估之间，识别踝关节X光报告中的常见错误。另外，将初次报告的时间评估为差异的原因。方法按照最初解释的协议标准对2 947份最终报告进行了审查。在发现差异的地方，通过特定的发现对其进行分类和整理。比较具有差异的报表和完整的数据集，从而通过发现来确定错误率。包含差异的报告按时间段进一步分类，将其与期望值进行比较，以确定在常规工作时间之外进行的初始报告是否与常规工作时间内进行的报告一样准确。结果94。4％的报告与最初的解释相符，2.9％的报告存在轻微差异，而2.7％的报告存在重大差异。在45.6％的报告中，没有放射学上可观察到的伤害。16.4％的报告包含踝外踝骨折，最常见的是Weber B型。在最初的报告中，未评论所有颈椎骨折的40.0％和所有立方形骨折的33.3％。漏诊率较低，但未评论2.5％的韦伯B型骨折。从00:00到07:59产生的主要差异报告的比例有所增加（预期= 15.0％，观察= 22.2％； p = 0.07908）。同样，在20:00和23:59之间发现的未成年人差异报告的数量也超过了预期（预期= 18.0％，观察= 34.1％，p = 0.00025）。结论急诊科对踝关节X光片的初次报告是高标准的，但是严重的漏诊发现强调需要及时进行高级检查。记者应提高对漏诊率不成比例的舟状，长方体，距骨和韦伯A型骨折的认识。该研究还发现证据支持正常工作时间（17：00-07：59）以外的踝关节X线初次报告错误率增加，特别是从20:00到23的轻微差异率显着增加：59。