Emergency department interpretation of CT of the brain: a systematic review

Evans, Lachlan R; Fitzgerald, Mark; Mitra, Biswadev; Varma, Dinesh

doi:10.1136/postgradmedj-2016-134491

Cited by 13 publications

(11 citation statements)

References 31 publications

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“…Nevertheless, it is well known that the S100B level is associated with the severity of the brain injury and the outcome of patients [ 11 , 17 ]. In clinical emergency situations, misinterpretation rates of CT scans of 2–24% have been reported with over 85% being detectable by reevaluation [ 35 , 36 ]. Consequently, the two exemplary case reports provided in this report emphasize that S100B concentrations – preferably from plasma samples for shortest TAT - should be determined for all TBI patients leading to CCT reevaluation in all cases with elevated S100B.…”

Section: Discussionmentioning

confidence: 99%

Plasma-based S100B testing for management of traumatic brain injury in emergency setting

Haselmann

Schamberger

Trifonova

et al. 2021

Practical Laboratory Medicine

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Background Serum biomarker S100B has been explored for its potential benefit to improve clinical decision-making in the management of patients suffering from traumatic brain injury (TBI), especially as a pre-head computed-tomography screening test for patients with mild TBI. Although being already included into some guidelines, its implementation into standard care is still lacking. This might be explained by a turnaround time (TAT) too long for serum S100B to be used in clinical decision-making in emergency settings. Methods S100B concentrations were determined in 136 matching pairs of serum and lithium heparin blood samples. The concordance of the test results was assessed by linear regression, Passing Pablok regression and Bland-Altman analysis. Bias and within- and between-run imprecision were determined by a 5 × 4 model using pooled patient samples. CT scans were performed as clinically indicated. Results Overall, S100B levels between both blood constituents correlated very well. The suitability of S100B testing from plasma was verified according to ISO15189 requirements. Using a cut-off of 0.105 ng/ml, a sensitivity and negative predictive value of 100% were obtained for identifying patients with pathologic CT scans. Importantly, plasma-based testing reduced the TAT to 26 min allowing for quicker clinical decision-making. The clinical utility of integrating S100B in TBI management is highlighted by two case reports. Conclusions Plasma-based S100B testing compares favorably with serum-based testing, substantially reducing processing times as the prerequisite for integrating S100B level into management of TBI patients. The proposed new clinical decision algorithm for TBI management needs to be validated in further prospective large-scale studies.

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Section: Discussionmentioning

confidence: 99%

Plasma-based S100B testing for management of traumatic brain injury in emergency setting

Haselmann

Schamberger

Trifonova

et al. 2021

Practical Laboratory Medicine

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“…Radiology education is an important issue in the field of emergency medicine, and emergency medicine residents undergo formal radiology training within their curriculum. However, EMPs may encounter some difficulties in interpreting methods such as chest radiography and head CT [22–25].…”

Section: Discussionmentioning

confidence: 99%

Awareness of Risks Associated with the Use of Plain X-Ray, Computed Tomography, and Magnetic Resonance Imaging Among Emergency Physicians and Comparison with that of Other Physicians: A Survey from Turkey

Demir

Akkaş

2019

Med Sci Monit

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BackgroundIncreased use of radiological imaging in all departments of medicine, especially in the Emergency Department, requires that physicians have a high level of knowledge regarding commonly used imaging methods and high awareness of the risks of examinations.Material/MethodsThe physicians were divided into 5 groups according to their specialties as emergency medicine physicians (EMPs), physicians from any specialty of internal sciences, physicians from any specialty of surgical sciences, general practitioners (GPs), and radiologists. A total of 700 physicians answered the questionnaire via email.Results15.7% of EMPs reported that they did not routinely perform any risk assessment before requesting computed tomography (CT); the rate was 17.9% for direct radiography and 29.3% for magnetic resonance imaging (MRI). The proportions of physicians who do not routinely perform risk assessments for direct radiography, CT, and MRI were as follows: 16.4%, 8.6%, and 19.3% in physicians from medical sciences, respectively; 25%, 22.9%, and 35% in physicians from surgical sciences, respectively; 24.3%, 14.3%, and 37.1% in GPs, respectively; and 27.1%, 22.1% and 37.1% in radiologists, respectively. In all radiological examinations, 1.4% of EMPs and ≤1.4% of other physicians routinely explain the risks associated with the imaging method to the patients, and discuss the risks and benefits of the imaging with the patients.ConclusionsAll physicians, including EMPs, need to undergo urgent training to increase their knowledge on risks of imaging methods and discussion of existing risks with patients.

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“…Since clinicians have to evaluate the radiographs and decide the treatment, especially in emergency units, many studies have been done comparing the cranial imaging interpretation skills of physicians in these branches with radiologists [4]. Brain diffusion MR images taken in emergency departments are often first evaluated by the emergency medicine clinician.…”

Section: Discussionmentioning

confidence: 99%

Cranial diffusion-MRI interpretation: comparison of emergency medicine and radiology residents

Kala

Açıksarı

2019

Disaster Emerg Med J

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INTRODUCTION: Today diagnosis and treatment of ischaemic stroke is based on cranial CT and MR. The aim of this study is to measure the ability of emergency medical and radiology resident physicians to evaluate brain diffusion MRI and to provide better and faster recognition of the vital condition of acute ischaemic cerebrovascular infarct patients. MATERIAL AND METHODS: 10 radiology and 10 emergency medicine residents were enrolled in the study. Of the 50 brain diffusion MRIs interpreted by trainees, 3 were normal, 13 had cerebral infarct, 27 had lacunar infarct, 3 had brain mass, 2 had hypoxic-ischaemic encephalopathy, 1 had MS and 1 had dermoid cyst. Each participant evaluated 50 digital diffusion MR images sequentially. They were asked to indicate whether there was a pathological lesion on the images, if the lesion was acute or chronic, what was the localization of the lesion, and ultimately the possible preliminary diagnosis. RESULTS: Experienced radiology resident physicians are found to be more accurate in determining MR results in comparison to their inexperienced colleagues in cerebral and lacunar infarcts (p < 0.01) but for noninfarct images, no difference was found between two groups (p > 0.05). Radiology residents outperformed emergency residents in both cerebral and lacunar infarct and non-infarct images (p < 0.01). CONCLUSIONS: In the study authors' opinion training and education is a must for MRI interpretation for emergency residents which might be vital for ischaemic cerebrovascular patients.

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Emergency department interpretation of CT of the brain: a systematic review

Abstract: Heterogeneity and the presence of bias limit our confidence in these findings. However, the variance in the interpretation of CTB between emergency clinicians and radiologists suggests that interventions towards improving accuracy may be useful.

Cited by 13 publications

References 31 publications

Plasma-based S100B testing for management of traumatic brain injury in emergency setting

Plasma-based S100B testing for management of traumatic brain injury in emergency setting

Awareness of Risks Associated with the Use of Plain X-Ray, Computed Tomography, and Magnetic Resonance Imaging Among Emergency Physicians and Comparison with that of Other Physicians: A Survey from Turkey

Cranial diffusion-MRI interpretation: comparison of emergency medicine and radiology residents

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