Bregman Stacey, Thau Elana, Pusic Martin, Perez Manuela, Boutis Kathy
Dr. Bregman: Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. Dr. Thau: Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. Dr. Pusic: Division of Pediatric Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard University; Boston, MA. Dr. Perez: Department of Diagnostic Imaging, University of Toronto, Ontario, Canada. Dr. Boutis: Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
J Contin Educ Health Prof. 2024;44(1):28-34. doi: 10.1097/CEH.0000000000000481. Epub 2022 Dec 21.
There is limited knowledge on pediatric chest radiograph (pCXR) interpretation skill among practicing physicians. We systematically determined baseline interpretation skill, the number of pCXR cases physicians required complete to achieve a performance benchmark, and which diagnoses posed the greatest diagnostic challenge.
Physicians interpreted 434 pCXR cases via a web-based platform until they achieved a performance benchmark of 85% accuracy, sensitivity, and specificity. Interpretation difficulty scores for each case were derived by applying one-parameter item response theory to participant data. We compared interpretation difficulty scores across diagnostic categories and described the diagnoses of the 30% most difficult-to-interpret cases.
240 physicians who practice in one of three geographic areas interpreted cases, yielding 56,833 pCXR case interpretations. The initial diagnostic performance (first 50 cases) of our participants demonstrated an accuracy of 68.9%, sensitivity of 69.4%, and a specificity of 68.4%. The median number of cases completed to achieve the performance benchmark was 102 (interquartile range 69, 176; min, max, 54, 431). Among the 30% most difficult-to-interpret cases, 39.2% were normal pCXR and 32.3% were cases of lobar pneumonia. Cases with a single trauma-related imaging finding, cardiac, hilar, and diaphragmatic pathologies were also among the most challenging.
At baseline, practicing physicians misdiagnosed about one-third of pCXR and there was up to an eight-fold difference between participants in number of cases completed to achieve the standardized performance benchmark. We also identified the diagnoses with the greatest potential for educational intervention.
执业医师对儿科胸部X光片（pCXR）解读技能的了解有限。我们系统地确定了基线解读技能、医师为达到性能基准所需完成的pCXR病例数量，以及哪些诊断构成了最大的诊断挑战。
医师通过基于网络的平台解读434例pCXR病例，直到他们达到85%的准确性、敏感性和特异性的性能基准。通过将单参数项目反应理论应用于参与者数据，得出每个病例的解读难度分数。我们比较了不同诊断类别的解读难度分数，并描述了最难解读的30%病例的诊断情况。
在三个地理区域之一执业的240名医师解读了病例，产生了56,833次pCXR病例解读。我们参与者的初始诊断性能（前50例）显示，准确性为68.9%，敏感性为69.4%，特异性为68.4%。达到性能基准所需完成的病例中位数为102例（四分位间距为69, 176；最小值、最大值为54, 431）。在最难解读的30%病例中，39.2%为正常pCXR，32.3%为大叶性肺炎病例。仅有一项与创伤相关影像学表现、心脏、肺门和膈肌病变的病例也极具挑战性。
在基线时，执业医师误诊了约三分之一的pCXR，在达到标准化性能基准所需完成的病例数量方面，参与者之间相差高达八倍。我们还确定了最有教育干预潜力的诊断。
