Independent emergency physician decision on patients undergoing Cranial computed tomography, a prospective cohort study.

Conference Paper

2016

Published in: http://dx.doi.org/10.1594/ecr2016/C-0249

Al-Aseri, F. Al Badr, K. Almohaimede, K. Almasar, Z. . 2016

Aims and objectives
"The provision of proper opportune care to patients visiting the emergency department
is greatly dependent on the appropriate interpretation of requested radiographs by the
emergency physician. Several studies have been conducted to evaluate the capabilities
of non-radiologist to interpret different imaging modalities. These were undertaken to
decide whether it may be proper for them to independently report radiological studies and
thus help to meet the rising need for on-call radiology"
"In this study, we ask whether Emergency department staffs are competent and could
make a safe independent decision upon their own interpretation of Brain computed
tomography image."
Methods and materials
"A prospective chart Audit of patients' undergone Brain Cmputed Tomography during the
months April- November 2014 was done. Six hundred and fifty five charts were analyzed.
The population was mixed of Adults and Children. Radiology reports were dictated by a
certified radiology consultant or an assistant consultant. Data were entered and analyzed
using statistical software SPSS version 21.0. By considering both, radiologist report and
Emergency physician impression, inter-rater reliability was assessed by calculating the
sensitivity, specificity, concordance and Kappa coefficient using the Radiologist opinion
as the reference standard."
"Kappa value of >0.75 considered as excellent agreement, 0.40-0.75 intermediate
agreement, and <0.40 poor agreement. A p-value of <0.05 and 95% confidence intervals
were used to indicate the statistical significance and prevision of the estimates."
Results
"
Six hundred and fifty five Brain Computed Tomography images were interpreted. Five
hundreds and ninety eight (91.3%) case were concordant with the radiologist report,
whereas 57 (8.7%) were discordant due to missed lesion by the emergency physician.
17.5 % of those missed lesions were fatal (e.g. Acute ischemia, Acute hemorrhage,
Multiple myeloma, pituitary mass). The remaining 82.5% were non-fatal lesions (e.g subgaleal hematoma, small vessel disease). Fatal lesions are those that will affect the
overnight management and need subspecialty consultation, whereas the nonfatal ones
are the cases that would not affect the management plan of the patient. However,
patients with missed fatal lesions, were followed up after the release of the radiologist
report. Patients with subgaleal hematoma, although the finding was not reported by the
emergency physician impression, it was managed because it was apparent clinically."
"The study results demonstrate that agreement between emergency physician and
radiologist specialist is excellent with a kappa value of 0.778.

• Publication Work Type: article
• Conference Location: ECR
• Conference Name: ECR
• Sponsoring Organization: ECR