Park Joon Bum, Cho Young Shin, Choi Hyuk Joong
Emergency Department, College of Medicine, Soonchunhyang University, Seoul, Korea.
Emergency Department, College of Medicine, Hanyang University, Seoul, Korea.
Am J Emerg Med. 2015 Apr;33(4):548-52. doi: 10.1016/j.ajem.2015.01.015. Epub 2015 Jan 20.
To assess whether inverted grayscale rib series, used alone or as an additional imaging modality, improves diagnostic accuracy of rib fractures of emergency medicine (EM) residents in minor chest trauma.
Twenty readers, including 5 junior and 5 senior EM residents and 10 fourth-year medical students, independently reviewed 110 patients' radiographs during 3 sessions. Session 1 used conventional grayscale rib series, session 2 used inverted grayscale rib series, and session 3 used both conventional and inverted grayscale images. The McNemar test was used to compare the sensitivities and specificities of the diagnostic methods, and to compare their sensitivities and specificities for detecting more than 3 rib fractures. Interobserver agreement was assessed using Cohen κ analysis.
For senior EM residents, there was no difference in sensitivity (P = .283) and accuracy (P = .888) between conventional rib series and the double-modality method. For junior EM residents and medical students, the double modality offered higher diagnostic sensitivity (P < .001, P = .001) and accuracy (P = .006, P = .002) than did conventional radiography. In cases with more than 3 rib fractures, who required specialist trauma care, the double modality provided greater sensitivity and accuracy among junior EM residents (P = .035 and P = .035, respectively) and medical students (P = .010, P = .010) than did conventional radiography.
In the diagnosis of rib fractures, the combined use of conventional and inverted grayscale rib series increases the diagnostic accuracy of less biased readers by conventional grayscale image like junior EM residents and medical students.
评估单独使用或作为附加成像方式的反转灰度肋骨系列，是否能提高急诊医学（EM）住院医师对轻度胸部创伤中肋骨骨折的诊断准确性。
20名读者，包括5名初级和5名高级EM住院医师以及10名四年级医学生，在3个阶段独立审查了110例患者的X光片。第一阶段使用传统灰度肋骨系列，第二阶段使用反转灰度肋骨系列，第三阶段使用传统和反转灰度图像。采用McNemar检验比较诊断方法的敏感性和特异性，并比较它们检测3根以上肋骨骨折的敏感性和特异性。使用Cohen κ分析评估观察者间的一致性。
对于高级EM住院医师，传统肋骨系列与双模态方法在敏感性（P = 0.283）和准确性（P = 0.888）方面没有差异。对于初级EM住院医师和医学生，双模态方法比传统X光摄影具有更高的诊断敏感性（P < 0.001，P = 0.001）和准确性（P = 0.006，P = 0.002）。在需要专科创伤护理的3根以上肋骨骨折病例中，双模态方法在初级EM住院医师（分别为P = 0.035和P = 0.035）和医学生（P = 0.010，P = 0.010）中比传统X光摄影具有更高的敏感性和准确性。
在肋骨骨折的诊断中，传统和反转灰度肋骨系列的联合使用提高了像初级EM住院医师和医学生这样对传统灰度图像偏差较小的读者的诊断准确性。
