Arhami Dolatabadi Ali, Baratloo Alireza, Rouhipour Alaleh, Abdalvand Ali, Hatamabadi Hamidreza, Forouzanfar Mohammadmehdi, Shojaee Majid, Hashemi Behrooz
Department of Emergency Medicine, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Department of Emergency Medicine, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Trauma Mon. 2013 Sep;18(2):86-9. doi: 10.5812/traumamon.12023. Epub 2013 Aug 14.
Many patients are brought to crowded emergency departments (ED) of hospitals every day for evaluation of head injuries, headaches, neurologic deficits etc. CT scan of the head is the most common diagnostic measure used to search for pathologies. In many EDs the initial interpretation of images are performed by emergency physicians (EP). Since most decisions are made based on the initial interpretation of the images by emergency physicians and not the radiologists, it is necessary to assess the accuracy of interpretations made by the former group.
The objective of this study was to compare the findings reported in the interpretation of head CTs by emergency physicians and compare to radiologists (the gold standard).
This was a prospective cross sectional study conducted from March to May 2009 in a teaching hospital in Tehran, Iran. All non-contrast head CTs obtained during the study period were copied on DVDs and sent separately to a radiologist, 6 emergency medicine (EM) attending physicians and 14 senior EM residents for interpretation. Clinical information pertaining to each patient was also sent with each CT. The radiologist's interpretation was considered as the gold standard and reference for comparison. Data from EM physicians and residents were compared with the reference as well as with each other and statistical analysis was performed using SPSS 18.5.
Out of 544 CT scans, EM physicians had 35 false negatives and 53 false positives compared with radiologist's interpretations (P < 0.0001). EM residents had 74 false negatives and 12 false positives compared with radiologist's interpretations (P < 0.0001).
Both EPs and ER residents either missed or falsely called a significant number of pathologies in their interpretations. The interpretations of EPs and ER residents were more sensitive and more specific, respectively. These findings revealed the need for increased training time in head CT reading for residents and the necessity of attending continuing medical education workshops for emergency physicians.
每天都有许多患者被送往医院拥挤的急诊科，以评估头部损伤、头痛、神经功能缺损等情况。头部CT扫描是用于查找病变的最常见诊断措施。在许多急诊科，图像的初步解读由急诊医生（EP）进行。由于大多数决策是基于急诊医生而非放射科医生对图像的初步解读做出的，因此有必要评估前一组医生解读的准确性。
本研究的目的是比较急诊医生对头部CT解读报告的结果，并与放射科医生（金标准）进行比较。
这是一项前瞻性横断面研究，于2009年3月至5月在伊朗德黑兰的一家教学医院进行。研究期间获得的所有非增强头部CT扫描均复制到DVD上，并分别发送给一名放射科医生、6名急诊医学（EM）主治医师和14名高级EM住院医师进行解读。与每位患者相关的临床信息也随每次CT扫描一同发送。放射科医生的解读被视为比较的金标准和参考。将EM医生和住院医师的数据与参考数据以及彼此进行比较，并使用SPSS 18.5进行统计分析。
在544例CT扫描中，与放射科医生的解读相比，EM医生有35例假阴性和53例假阳性（P < 0.0001）。与放射科医生的解读相比，EM住院医师有74例假阴性和12例假阳性（P < 0.0001）。
急诊医生和急诊住院医师在解读中均遗漏或错误判断了大量病变。急诊医生和急诊住院医师的解读分别更具敏感性和特异性。这些发现表明住院医师需要增加头部CT阅片培训时间，急诊医生有必要参加继续医学教育研讨会。
