Value of Re-examining X-ray Films of Outpatients Attending Accident Services

How good are emergency department Senior House Officers at interpreting X-rays following radiographers?? triage?

“…In comparative terms, the results here are similar to those of previous studies [2][3][4][6][7][8][9]. For the combined system (red dot and SHO diagnosis), the FNR was 5.3% (4.0-6.9%) and the FPR was 8.9% (7.3-10.1%) (the denominator was taken to be the total number of X-rays).…”

“…A marked variation is found in the reported figures: for ED physicians, the false negative rates (FNRs) range from 0.5 to 5% [2,[4][5][6][7][8][9] and the false positive rates (FPRs) range from 1.2 to 11.4% [2]. Radiographers' diagnostic performance has also varied with FNR ranging from 4.5 to 4.6% [2,10] and FPR from 2.5 to 4.7% [2].…”

“…Certainly, the reporting of films within 24 h has been shown to be clinically effective [4,8], although the effectiveness seemed to depend on the experience of the reviewing radiologist [8]. Despite this, immediate reporting is not widespread.…”

An assessment of the clinical effects of reporting accident and emergency radiographs

“…A daily joint review of X-ray films, by accident service officers with a radiologist, in order to avoid such errors has been suggested (Galasko and Monahan, 1971). In most institutions this would be impractical, but when staffing levels permit or when the error rate is high, such an arrangement may need to be considered.…”

The staffing of departments.

“…X-ray films are often reviewed daily or weekly with junior staff as a teaching exercise, and should indeed be an integral part of the training programme. 9 Psychiatry-The worst disaster that can befall an accident and emergency department, it is sometimes said, is a psychiatric emergency, which can create havoc for hours. The particular problems are getting a speedy psychiatric opinion (since psychiatrists are often based on separate hospitals) and finding a bed (here the restrictions of catchment areas are especially troublesome).…”