Jackson Myriam E, Henderson Julia E
Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Greetwell Road, Lincoln LN2 2QS, England.
Emerg Radiol. 2010 Mar;17(2):87-93. doi: 10.1007/s10140-009-0836-4. Epub 2009 Oct 16.
Literature review and anecdotal evidence appears to suggest a variation in the number of imaging projections used to demonstrate recent injury to the wrist, dependent on which Accident and Emergency (A&E) radiology department a patient attends. Some departments routinely undertake two projections (dorsi-palmar and lateral) whilst others include a dorsi-palmar oblique projection. The aim of this research was to assess if the inclusion of the additional projection altered the sensitivity of bony injury detection. Four readers reported 250 anonymous image sets, initially of two projections, and then at a later date, reported the same two projections along with the additional third projection, however, they did not have access to their previous reports. The readers identified 4.4% more fractures with the additional projection. Additionally, 2.8% of the fractures had not been identified by any reader on two projections, but were identified by all readers with three projections. Statistical analysis using chi-square test identified a statistical difference in the bone injury detection sensitivity (p < 0.001) when including a third projection. Kappa statistics assessed inter-observer correlation which increased from 0.68 on two projections to 0.78 on three projections. The number of equivocal reports reduced to less than half when the third projection was included. There is an increase in the sensitivity of bone injury identification with the additional projection, which is likely to be of significance to patients and A&E departments, with obviously beneficial social and financial implications.
文献综述和轶事证据似乎表明，用于显示手腕近期损伤的影像学投照数量存在差异，这取决于患者就诊的 Accident and Emergency（A&E，急诊）放射科。一些科室常规进行两种投照（背掌位和侧位），而其他科室则包括背掌斜位投照。本研究的目的是评估额外投照的加入是否会改变骨损伤检测的敏感性。四位阅片者报告了 250 套匿名影像集，最初是两种投照的影像，之后在较晚日期，报告同样的两种投照以及额外的第三种投照，然而，他们无法获取自己之前的报告。阅片者在有额外投照时多识别出了 4.4%的骨折。此外，2.8%的骨折在两种投照时未被任何阅片者识别，但在三种投照时被所有阅片者识别。使用卡方检验的统计分析表明，加入第三种投照时，骨损伤检测敏感性存在统计学差异（p < 0.001）。Kappa 统计评估了观察者间的相关性，其从两种投照时的 0.68 增加到三种投照时的 0.78。当加入第三种投照时，疑似报告的数量减少到不到一半。额外投照增加了骨损伤识别的敏感性，这可能对患者和急诊科室具有重要意义，显然具有有益的社会和经济影响。
