Radiographic interpretation of the appendicular skeleton: A comparison between casualty officers, nurse practitioners and radiographers

Coleman, L.F.; Piper, K.

doi:10.1016/j.radi.2007.12.001

Cited by 57 publications

(66 citation statements)

References 27 publications

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“…While the overall sensitivity of 80.5% in this study concurs with the current literature for identification of all appendicular skeletal fractures combined (ranging from 70%–98%), 2–7 it shows a markedly reduced sensitivity of 45.9% for cases of non‐displaced fractures and demonstrates the importance of an appropriately qualified radiologist report in all instances. Displaced fractures, which ought to be readily identifiable by referring clinicians, accounted for 16.5% of all radiographs, and only 9.3% of radiographs contained a fracture that may not have been readily apparent to the referring clinician.…”

Section: Discussionsupporting

confidence: 86%

Evaluating the true clinical utility of the red dot system in radiograph interpretation

Brown

Leschke

2012

J Med Imag Rad Onc

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Introduction: The ‘red dot’, or ‘asterisk’, system is used in many hospitals as a method for radiographers to identify potential abnormalities on plain radiographs prior to reporting by radiologists. While published studies into the accuracy of the ‘red dot’ system exist, analysis of its reliability in identifying subtle pathology is lacking. This is relevant because the prevalence and apparent success of the ‘red dot’ system has been cited by some authors as justification for non‐radiologist reporting of medical imaging. It is important that all systems within medical imaging add value, and this audit evaluates the accuracy and clinical value of the ‘red dot’ system, particularly in the critical area of detecting undisplaced fractures. Methods: All appendicular musculoskeletal trauma radiographs performed in the Department of Emergency Medicine at a major Australian metropolitan hospital over a continuous four‐month period were retrospectively assessed to evaluate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the ‘red dot’ system. The presence or absence of an asterisk was correlated with validated radiologist reports. A sub‐analysis of fractures displaced <1mm was also performed. Results: A total of 3638 radiographs were assessed and 938 (25.8%) fractures identified; 338 (9.3%) contained undisplaced fractures. Overall sensitivity and specificity of the ‘red dot’ in detecting appendicular fractures are 80.4% and 98.0%, respectively. PPV is 93.6% and NPV is 93.5%. However, the accuracy of the ‘red dot’ in detecting undisplaced fractures is significantly reduced, with a sensitivity of 45.9% and a PPV of 74.8%. Conclusions: Detection of subtle abnormalities is fundamental to the service provided by radiologists. The ‘red dot's’ inability to reliably detect undisplaced fractures following trauma limits its value within a tertiary radiology department and suggests that role extension of plain film reporting to non‐radiologists has potential to yield less accurate assessments. To maintain the highest quality of medical imaging services and standards of patient care, it is optimal that clinical decisions are based upon radiograph reports issued by medical specialists who have completed appropriate radiology training. Strategies to maintain this are suggested.

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Section: Discussionsupporting

confidence: 86%

Evaluating the true clinical utility of the red dot system in radiograph interpretation

Brown

Leschke

2012

J Med Imag Rad Onc

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“…In one study, Radiographers underestimated their ability in image interpretation, whereas Nurse Practitioners and Casualty Officers overrated their abilities, again suggesting there may be issues with Radiographer confidence. 22 As ENPs are successfully discharging trauma patients on review of radiographs, this demonstrates the potential for RLD. A pilot RLD study by Snaith 23 involved A&E clinicians creating a management plan at initial assessment detailing discharge instructions for the Radiographer to follow.…”

Section: Introductionmentioning

confidence: 88%

“…They were derived from concepts emerging from a literature review, including job satisfaction, inter-professional working, improving the patient journey and meeting government targets. 8,10,17,22 Determinants of job satisfaction include autonomy, variety, salary, promotional opportunities and staff collaboration. 25e27 Initially participants were asked to choose the type of hospital they worked in from six options.…”

Section: Questionnaire Designmentioning

confidence: 99%

Attitudes of radiographers to radiographer-led discharge: A survey

Lumsden

Cosson

2015

Radiography

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“…The latter initiative introduced and supported inherent notions of role extension and skill mix, through proposing new practitioner definitions; in particular those of advanced and consultant practitioner 8 . Despite the clear evidence of potential service enhancement 9,10,11,12 , such change, considered contentious in some areas, has led to a patchy and often incoherent process of implementation across the UK, based as often on professional preference or opposition, than service need or an evidence base 5,13,14,15,16,17 .…”

Section: Introductionmentioning

confidence: 99%