Comparing the interpretation of emergency department computed tomography between emergency physicians and attending radiologists: A multicenter study

Güven, Ramazan; Akça, Ali Haydar; Çaltılı, Çilem; Şaşmaz, Muhammed İkbal; Kaykısız, Eylem Kuday; Baran, Sultan; Şahin, Levent; Arı, Asım; Eyüpoğlu, Gökhan; Kirpat, Vedat

doi:10.4103/njcp.njcp_22_18

Cited by 10 publications

(1 citation statement)

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“…The universal onus of reducing morbidity and mortality through judicious operative and nonoperative decisions is time-dependent and cannot be implemented without the use of advanced imaging supplements, such as CT [35]. Because many institutions do not maintain on-call services, and because studies have shown the acceptable accuracy of scan interpretation by properly trained non-radiologists, we believe that a decisional algorithm combining clinical pathways with radiological findings might be beneficial for the rapid assessment of cases presenting with acute abdominopelvic pain [36]. Pattern recognition and identification of clinical vignettes coupled with the use of the principles of the ABC of lesion enhancement and the application of anatomical concepts form the scaffolding triad for a combined clinical-radiological algorithm for rapid assessment and optimal CPS (Figure 7).…”

Section: Merging Clinical Pathways With Radiological Cuesmentioning

confidence: 99%

When Not to Operate on Acute Cases—A Surgeon’s Perspective on Rapid Assessment of Emergency Abdominopelvic Computed Tomography

Alius,

Serban,

Tribus

et al. 2023

J. Imaging

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Clinical problem solving evolves in parallel with advances in technology and discoveries in the medical field. However, it always reverts to basic cognitive processes involved in critical thinking, such as hypothetical–deductive reasoning, pattern recognition, and compilation models. When dealing with cases of acute abdominal pain, clinicians should employ all available tools that allow them to rapidly refine their analysis for a definitive diagnosis. Therefore, we propose a standardized method for the quick assessment of abdominopelvic computed tomography as a supplement to the traditional clinical reasoning process. This narrative review explores the cognitive basis of errors in reading imaging. It explains the practical use of attenuation values, contrast phases, and windowing for non-radiologists and details a multistep protocol for finding radiological cues during CT reading and interpretation. This systematic approach describes the salient features and technical tools needed to ascertain the causality between clinical patterns and abdominopelvic changes visible on CT scans from a surgeon’s perspective. It comprises 16 sections that should be read successively and that cover the entire abdominopelvic region. Each section details specific radiological signs and provides clear explanations for targeted searches, as well as anatomical and technical hints. Reliance on imaging in clinical problem solving does not make a decision dichotomous nor does it guarantee success in diagnostic endeavors. However, it contributes exact information for supporting the clinical assessments even in the most subtle and intricate conditions.

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Section: Merging Clinical Pathways With Radiological Cuesmentioning

confidence: 99%

When Not to Operate on Acute Cases—A Surgeon’s Perspective on Rapid Assessment of Emergency Abdominopelvic Computed Tomography

Alius,

Serban,

Tribus

et al. 2023

J. Imaging

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Assessment of cervical spine CT scans by emergency physicians: A comparative diagnostic accuracy study in a non‐clinical setting

et al. 2022

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Objectives To determine and compare the diagnostic accuracy of assessing injuries on cervical spine computed tomography (CT) scans by trained emergency physicians and radiologists, both in a non‐clinical setting. Methods In this comparative diagnostic accuracy study, 411 cervical spine CT scans, of which 120 contained injuries (fractures and/or dislocations), were divided into 8 subsets. Eight emergency physicians received focused training and assessed 1 subset each before and after training. Four radiologists assessed 2 subsets each. Diagnostic accuracy between both groups was compared. The reference standard used was a multiverified data set, assessed by radiologists, neurosurgeons, and emergency physicians. The neurosurgeons also classified whether an "injury in need of stabilizing therapy" (IST) was present. Results Posttraining, the emergency physicians demonstrated increased sensitivity and specificity for identifying cervical spine injuries compared to pretraining: sensitivity 88% (95% confidence interval [CI] 80% to 93%) versus 80% (95% CI 72% to 87%) and specificity 89% (95% CI 85% to 93%) versus 86% (95% CI 81% to 89%). When comparing the trained emergency physicians to the group of radiologists, no difference in sensitivity was found, 88% (95% CI 80% to 83%); however, the radiologists showed a significantly higher specificity ( P < 0.01): 99% (95% CI 96% to 100%). In the 12% (15 scans) with missed injuries, emergency physicians missed more ISTs than radiologists, 6 versus 4 scans; however, this difference was not significant ( P = 0.45). Conclusion After focused training and in a non‐clinical setting, no significant difference was found between emergency physicians and radiologists in ruling out cervical spine injuries; however, the radiologists achieved a significantly higher specificity.

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Interpretation of Emergency CT Scans of the Head in Trauma: Neurosurgeon vs Radiologist

Parag

Hardcastle

2022

World j. surg.

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Background Traumatic brain injury (TBI) is a major cause of mortality and morbidity across all ages in all countries. Management of the patient with TBI is time critical. Emergency computed tomography (CT) scans of the head are often assessed by neurosurgeons and patient management plans are implemented before the final radiological report is released in hospitals, particularly where there is a shortage of radiologists in LMIC. The aims of this study were to identify discrepancies in the interpretation of CT scans of the head in patients with isolated head injury between the neurosurgeon and radiologist and to assess if these differences impacted patient management. Methods This 6-month long prospective observational study was performed at a tertiary hospital in South Africa. The study population comprised 347 patients with isolated head injury who had a CT scan of the head performed on admission. The neurosurgeons' initial CT scan interpretation and the final radiological report were compared. Results Out of 347 CT head scans, the neurosurgeons correctly interpreted 318 cases. Of the 29 incorrectly interpreted cases, there were 17 false negatives and 12 cases with mismatching abnormalities. The concordance rate was 91.64% (95% CI 88.73-94.55) with a kappa of 0.78. An accuracy rate of 95.33% (95% CI 92.63-97.26) was achieved by the neurosurgeon. No patient was negatively impacted by any neurosurgical error in misinterpretation. Conclusions In the interpretation of CT head scans in trauma, there is good neurosurgical and radiological interobserver agreement without negative patient impact. The neurosurgeons' interpretation of CT scans of the head in TBI is safe especially when radiology reports are not timeously available.

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Comparing the interpretation of emergency department computed tomography between emergency physicians and attending radiologists: A multicenter study

Cited by 10 publications

References 0 publications

When Not to Operate on Acute Cases—A Surgeon’s Perspective on Rapid Assessment of Emergency Abdominopelvic Computed Tomography

When Not to Operate on Acute Cases—A Surgeon’s Perspective on Rapid Assessment of Emergency Abdominopelvic Computed Tomography

Assessment of cervical spine CT scans by emergency physicians: A comparative diagnostic accuracy study in a non‐clinical setting

Interpretation of Emergency CT Scans of the Head in Trauma: Neurosurgeon vs Radiologist

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