Lufkin K C, Smith S W, Matticks C A, Brunette D D
Emergency Medicine Department, St. Luke's Hospital, Duluth, USA.
Ann Emerg Med. 1998 Feb;31(2):202-7. doi: 10.1016/s0196-0644(98)70307-5.
To determine whether radiologists' review of radiographs is unwarranted when emergency physicians are confident in their interpretations.
This was a prospective, descriptive study. Treating emergency physicians at a high-volume, urban teaching hospital and a moderate-volume nonteaching hospital indicated their confidence or lack of confidence in their plain-film radiographic study interpretations. All radiographs were then reviewed by radiologists according to the preexisting practice of each hospital. A total of 16,410 emergency department radiographic studies were included, comprising consecutive patients at each hospital. Charts of all discordant readings in the confident group were reviewed and judged clinically significant if treatment was altered. Charges for radiologic review of the confident ED interpretations were calculated.
The ED physicians were confident in 9,599 sets of radiographs out of a total of 16,410 (58%). Discordant interpretation rates for the "confident" and "not confident" groups were 1.2% and 3.1%, respectively (difference, 1.9%; 95% confidence interval [CI] of the difference, 1.44% to 2.36%). Review of the 118 discordant interpretations in the confident group demonstrated that 11 were significant. Few management changes were made as a result of radiologists' review of these radiographs. Total radiology review charges for the confident group were $215,338. Therefore the average radiology charge for each significant discordant interpretation was $19,576.
Of 9,599 sets of radiographs interpreted confidently by the emergency physicians in this study, there were 11 clinically significant discordant interpretations (0.1%). The standard practice of radiologists' review of all ED radiographs may not be justifiable.
确定当急诊医生对其X光片解读有信心时，放射科医生对X光片的复查是否没有必要。
这是一项前瞻性描述性研究。在一家高流量的城市教学医院和一家中等流量的非教学医院，负责治疗的急诊医生表明他们对其X光片解读有信心或缺乏信心。然后，所有X光片由放射科医生根据每家医院的既有做法进行复查。共纳入16410例急诊科X光检查，包括每家医院的连续患者。对信心组中所有不一致读数的病历进行复查，若治疗方案改变则判定为具有临床意义。计算对急诊医生有信心的解读进行放射学复查的费用。
在总共16410例X光片中，急诊医生有信心的有9599例（58%）。“有信心”组和“无信心”组的不一致解读率分别为1.2%和3.1%（差异为1.9%；差异的95%置信区间[CI]为1.44%至2.36%）。对信心组中118例不一致解读的复查表明，其中11例具有临床意义。由于放射科医生对这些X光片的复查，几乎没有进行治疗方案的改变。信心组的放射学复查总费用为215338美元。因此，每例具有临床意义的不一致解读的平均放射学费用为19576美元。
在本研究中，急诊医生自信解读的9599例X光片中，有11例具有临床意义的不一致解读（0.1%）。放射科医生对所有急诊科X光片进行复查的标准做法可能不合理。
