Lee Seong Geun, Cho Hanjin, Kim Joo Yeong, Song Juhyun, Park Jong-Hak
Department of Emergency Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
Clin Exp Emerg Med. 2021 Sep;8(3):207-215. doi: 10.15441/ceem.20.118. Epub 2021 Sep 30.
Accurate interpretation of computed tomography (CT) scans is critical for patient care in the emergency department. We aimed to identify factors associated with an incorrect interpretation of abdominal CT by novice emergency residents and to analyze the characteristics of incorrectly interpreted scans.
This retrospective analysis of a prospective observational cohort was conducted at three urban emergency departments. Discrepancies between the interpretations by postgraduate year-1 (PGY-1) emergency residents and the final radiologists' reports were assessed by independent adjudicators. Potential factors associated with incorrect interpretation included patient age, sex, time of interpretation, and organ category. Adjusted odds ratios (aORs) for incorrect interpretation were calculated using multivariable logistic regression analysis.
Among 1,628 eligible cases, 270 (16.6%) were incorrect. The urinary system was the most correctly interpreted organ system (95.8%, 365/381), while the biliary tract was the most incorrectly interpreted (28.4%, 48/169). Normal CT images showed high false-positive rates of incorrect interpretation (28.2%, 96/340). Organ category was found to be a major determinant of incorrect interpretation. Using the urinary system as a reference, the aOR for incorrect interpretation of biliary tract disease was 9.20 (95% confidence interval, 5.0-16.90) and the aOR for incorrectly interpreting normal CT images was 8.47 (95% confidence interval, 4.85-14.78).
Biliary tract disease is a major factor associated with incorrect preliminary interpretations of abdominal CT scans by PGY-1 emergency residents. PGY-1 residents also showed high false-positive interpretation rates for normal CT images. Emergency residents' training should focus on these two areas to improve abdominal CT interpretation accuracy.
准确解读计算机断层扫描（CT）对于急诊科患者的治疗至关重要。我们旨在确定与急诊住院医师对腹部CT解读错误相关的因素，并分析解读错误的扫描特征。
在三个城市急诊科对一个前瞻性观察队列进行了这项回顾性分析。由独立评审员评估一年级住院医师（PGY-1）的解读与最终放射科医生报告之间的差异。与解读错误相关的潜在因素包括患者年龄、性别、解读时间和器官类别。使用多变量逻辑回归分析计算解读错误的调整优势比（aOR）。
在1628例符合条件的病例中，270例（16.6%）解读错误。泌尿系统是解读最准确的器官系统（95.8%，365/381），而胆道系统是解读错误最多的（28.4%，48/169）。正常CT图像显示解读错误的假阳性率很高（28.2%，96/340）。发现器官类别是解读错误的主要决定因素。以泌尿系统为参照，胆道疾病解读错误的aOR为9.20（95%置信区间，5.0 - 16.90），正常CT图像解读错误的aOR为8.47（95%置信区间，4.85 - 14.78）。
胆道疾病是与PGY-1急诊住院医师对腹部CT扫描初步解读错误相关的主要因素。PGY-1住院医师对正常CT图像的解读也显示出较高的假阳性率。急诊住院医师的培训应聚焦于这两个方面，以提高腹部CT解读的准确性。
