Khoo Nee Chen, Duffy Martin
University of New South Wales, St Vincent's Hospital, Sydney, New South Wales, Australia.
Emerg Med Australas. 2007 Apr;19(2):122-8. doi: 10.1111/j.1742-6723.2007.00914.x.
To assess the accuracy of 'out of hours' (17.00-08.00 hours) non-contrast head computed tomography (NCHCT) scan interpretation by senior ED medical staff.
The study was undertaken in an inner-city tertiary hospital in Sydney. A sample of 315 consecutive 'out of hours' NCHCT scans was compiled from a log book in the Medical Imaging Department and randomized into 21 sets of 15 scans. The scans were reviewed by emergency physicians and registrars recruited for the study and their interpretations were compared with the formal radiologist report.
Seven emergency physicians and 14 registrars took part in the study. Two hundred and eighty-seven ED interpretations were used in the 2 x 2 table analysis. The overall observed agreement was 0.67 (95% confidence interval [CI] 0.61-0.72), sensitivity 0.57 (95% CI 0.45-0.69), specificity 0.70 (95% CI 0.64-0.76) and kappa 0.24 (95% CI 0.13-0.36). There were 32 false negative interpretations including three small contre coup contusions and three subdural haemorrhages.
'Out of hours' NCHCT scan interpretation by senior ED medical staff is only correct two-thirds of the time. Further education for all senior ED staff is indicated to improve our accuracy. The safety of NCHCT scan interpretation by senior ED medical staff needs further study.
评估急诊科高级医务人员对非工作时间（17:00 - 08:00）非增强头部计算机断层扫描（NCHCT）的解读准确性。
该研究在悉尼市中心的一家三级医院进行。从医学影像科的日志中收集了315例连续的非工作时间NCHCT扫描样本，并随机分为21组，每组15次扫描。由为该研究招募的急诊医师和住院医师对扫描进行评估，并将他们的解读与放射科医生的正式报告进行比较。
7名急诊医师和14名住院医师参与了该研究。在2×2表格分析中使用了287份急诊科的解读。总体观察一致性为0.67（95%置信区间[CI] 0.61 - 0.72），敏感性为0.57（95% CI 0.45 - 0.69），特异性为0.70（95% CI 0.64 - 0.76），kappa值为0.24（95% CI 0.13 - 0.36）。有32例假阴性解读，包括3例小的对冲性脑挫伤和3例硬膜下出血。
急诊科高级医务人员对非工作时间NCHCT扫描的解读只有三分之二是正确的。建议对所有急诊科高级工作人员进行进一步培训以提高准确性。急诊科高级医务人员对NCHCT扫描解读的安全性需要进一步研究。
