McLauchlan C A, Jones K, Guly H R
Royal Devon and Exeter (Wonford) Hospital, Exeter, UK.
J Accid Emerg Med. 1997 Sep;14(5):295-8. doi: 10.1136/emj.14.5.295.
To investigate how well junior doctors in accident and emergency (A&E) were able to diagnose significant x ray abnormalities after trauma and to compare their results with those of more senior doctors.
49 junior doctors (senior house officers) in A&E were tested with an x ray quiz in a standard way. Their results were compared with 34 consultants and senior registrars in A&E and radiology, who were tested in the same way. The quiz included 30 x rays (including 10 normal films) that had been taken after trauma. The abnormal films all had clinically significant, if sometimes uncommon, diagnoses. The results were compared and analysed statistically.
The mean score for the abnormal x rays for all the junior doctors was only 32% correct. The 10 junior doctors were more experience scored significantly better (P < 0.001) but their mean score was only 48%. The mean score of the senior doctors was 80%, which was significantly higher than the juniors (P < 0.0001).
The majority of junior doctors misdiagnosed significant trauma abnormalities on x ray. Senior doctors scored well, but were not infallible. This suggests that junior doctors are not safe to work on their own in A&E departments. There are implications for training, supervision, and staffing in A&E departments, as well as a need for fail-safe mechanisms to ensure adequate patient care and to improve risk management.
调查急症室初级医生在创伤后对X线显著异常的诊断能力，并将他们的结果与资深医生的结果进行比较。
对49名急症室初级医生（高级住院医生）进行了标准方式的X线测试。将他们的结果与34名急症室及放射科的顾问医生和高级住院医生的结果进行比较，这些医生接受了相同方式的测试。测试包括30张创伤后的X线片（包括10张正常片子）。异常片子均有临床上显著的诊断，尽管有时并不常见。对结果进行比较并进行统计学分析。
所有初级医生对异常X线片的平均正确得分仅为32%。10名经验更丰富的初级医生得分显著更高（P < 0.001），但他们的平均得分也仅为48%。资深医生的平均得分是80%，显著高于初级医生（P < 0.0001）。
大多数初级医生对创伤后的显著X线异常诊断错误。资深医生得分较高，但并非绝对正确。这表明初级医生在急症室单独工作并不安全。这对急症室的培训、监督和人员配备有影响，同时需要有故障安全机制来确保充分的患者护理并改善风险管理。
