Talebian Mohammad-Taghi, Kavandi Elahe, Farahmand Shervin, Shahlafar Neda, Arbab Mona, Seyedhosseini-Davarani Seyedhossein, Nejati Amir, Bagheri-Hariri Shahram
Emergency Medicne Department, Tehran University of Medical Sciences, Tehran, Iran.
Emerg Radiol. 2015 Jun;22(3):261-8. doi: 10.1007/s10140-014-1279-0. Epub 2014 Oct 30.
Requesting non-enhanced brain CT scans for trauma and non-trauma patients in ER is very common. In this study, the impact of incorrect brain CT scan interpretations by emergency medicine team on patients' primary and secondary outcome was evaluated in the setting where neuroradiologist reports are not always available. During a 3-month period, 450 patients were enrolled and followed for 28 days. All CT scans were interpreted by the emergency medicine team, and the patients were managed accordingly. Neuroradiologists' reports were considered as gold standard, and the patients were then grouped into the agreement or disagreement group. A panel of experts further evaluated the disagreement group and placed them in clinically significant and insignificant. The agreement rate between emergency medicine team and neuroradiologists was 86.4 %. The inter-rater reliability between emergency team and neuroradiologists was substantial (kappa = 0.68) and statistically significant (p < 0.0001). Only five patients did not receive the necessary management, and among them, only one patient died, and 12 patients received unnecessary management including repeated CT scan, brain MRI, and lumbar puncture. Forty-one patients were managed clinically appropriate in spite of misinterpretation. A 28-day follow-up showed a mortality rate of 0.2 %; however, expert panel believed the death of this patient was not related to the CT scan misinterpretation. We conclude that although the disagreement rate in this study was 13.6 %, primary and secondary outcomes were not clinically jeopardized according to the expert panel idea and 28-day follow-up results.
在急诊室为创伤和非创伤患者请求进行非增强脑部CT扫描是非常常见的。在本研究中，在神经放射科医生报告并非总是可用的情况下，评估了急诊医学团队对脑部CT扫描的错误解读对患者主要和次要结局的影响。在3个月的时间里，招募了450名患者并随访28天。所有CT扫描均由急诊医学团队解读，并据此对患者进行管理。将神经放射科医生的报告视为金标准，然后将患者分为一致或不一致组。一个专家小组进一步评估了不一致组，并将他们分为具有临床意义和无临床意义两组。急诊医学团队与神经放射科医生之间的一致率为86.4%。急诊团队与神经放射科医生之间的评分者间信度很高（kappa = 0.68）且具有统计学意义（p < 0.0001）。只有5名患者没有接受必要的管理，其中只有1名患者死亡，12名患者接受了不必要的管理，包括重复CT扫描、脑部MRI和腰椎穿刺。尽管存在解读错误，但仍有41名患者得到了临床适当的管理。28天的随访显示死亡率为0.2%；然而，专家小组认为该患者的死亡与CT扫描解读错误无关。我们得出结论，尽管本研究中的不一致率为13.6%，但根据专家小组的意见和28天的随访结果，主要和次要结局在临床上并未受到危及。
