Wechsler R J, Spettell C M, Kurtz A B, Lev-Toaff A S, Halpern E J, Nazarian L N, Feld R I, Needleman L, Alexander A A
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia PA 19107, USA.
Radiology. 1996 Jun;199(3):717-20. doi: 10.1148/radiology.199.3.8637994.
To determine the effects of level of training and other factors on the rate of discrepant interpretation of emergency body computed tomographic (CT) scans by trainees and staff radiologists.
Five hundred ninety-eight consecutive emergency CT studies were prospectively interpreted by radiology residents or board-certified body imaging fellows over a 12-month period. Each interpretation was reviewed within 12 hours by an attending body CT radiologist. Major discrepancies between staff radiologists' and trainees' interpretations were defined and those with the potential to affect immediate patient therapy; minor discrepancies were defined ad those without such potential. The effects on discrepancy rates were examined for abnormal versus normal CT findings and trauma versus nontrauma cases.
Major and minor discrepancy rates were 1.2% and 6.5%, respectively, between interpretations made by the trainee and the staff radiologist. Overall, fellows demonstrated statistically significantly lower discrepancy rates than did senior of junior residents (5.9%, 13.7%, and 13.3%, respectively). The discrepancy rate was higher when CT findings were abnormal than when they were normal (13.5% vs 2.6%). There were no differences between discrepancy rates for trauma and nontrauma cases.
Experience appeared to decrease discrepancy rates. Trainees were more likely to miss findings than to read normal scans as abnormal.
确定培训水平及其他因素对实习医生和放射科工作人员对急诊身体计算机断层扫描（CT）结果不一致解读率的影响。
在12个月期间，放射科住院医师或获得委员会认证的身体影像研究员对598例连续的急诊CT研究进行前瞻性解读。每次解读在12小时内由一名主治身体CT放射科医生进行复查。定义了放射科工作人员和实习医生解读之间的主要差异以及那些可能影响患者即时治疗的差异；定义了次要差异为那些没有这种可能性的差异。研究了CT结果异常与正常以及创伤与非创伤病例对差异率的影响。
实习医生和放射科工作人员的解读之间，主要差异率和次要差异率分别为1.2%和6.5%。总体而言，研究员的差异率在统计学上显著低于高级或初级住院医师（分别为5.9%、13.7%和13.3%）。CT结果异常时的差异率高于正常时（13.5%对2.6%）。创伤和非创伤病例的差异率没有差异。
经验似乎会降低差异率。实习医生更有可能漏诊结果，而不是将正常扫描误读为异常。
