Perron A D, Huff J S, Ullrich C G, Heafner M D, Kline J A
Departments of Emergency Medicine, Radiology, and Neurosurgery, Carolinas Medical Center, Charlotte, NC, USA.
Ann Emerg Med. 1998 Nov;32(5):554-62. doi: 10.1016/s0196-0644(98)70032-0.
Cranial computed tomography (CT) has assumed a critical role in the practice of emergency medicine for the evaluation of intracranial emergencies. Several recent studies have documented a deficiency in the emergency physician's ability to interpret these studies. The purpose of this study was to quantify the baseline ability of emergency medicine residents to interpret cranial CTs, and to test a novel method of cranial CT interpretation designed for the emergency physician in training.
A standardized pretest was administered to assess baseline ability to interpret CT scans. A standardized posttest was given 3 months after the course. Each test consisted of 12 CT scans with a short accompanying history. All scans were validated by 3 expert reviewers for difficulty and diagnosis. A 2-hour course based on the mnemonic "Blood Can Be Very Bad" was then administered. "Blood" reminds the examiner to search for blood, "Can" prompts the examiner to identify 4 key cisterns, "Be" denotes the need to examine the brain, "Very" prompts a review of the 4 ventricles, and finally "Bad" reminds the examiner to evaluate the bones of the cranium.
Eighty-three residents at 5 institutions were initially examined. The mean percentage correct before the course was 60% (95% confidence interval [CI] 58%-64%) on the standardized pretest. At retesting 3 months after the course, the accuracy rate increased to 78% (n=61, 95% CI 75%-81%, P<.001 paired t test).
Emergency medicine residents are deficient in their ability to interpret cranial CT scans. A novel educational course was demonstrated to significantly improve this ability.
头颅计算机断层扫描（CT）在急诊医学实践中对颅内急症的评估起着关键作用。最近的几项研究记录了急诊医生解读这些检查结果的能力存在不足。本研究的目的是量化急诊医学住院医师解读头颅CT的基线能力，并测试一种为急诊医学培训医师设计的新型头颅CT解读方法。
进行标准化的预测试以评估解读CT扫描的基线能力。在课程结束3个月后进行标准化的后测试。每次测试包括12张CT扫描，并附有简短的病史。所有扫描结果均由3名专家评审员对难度和诊断进行验证。然后开展了一门基于记忆口诀“Blood Can Be Very Bad”的2小时课程。“Blood”提醒检查者寻找血液，“Can”促使检查者识别4个关键脑池，“Be”表示需要检查脑实质，“Very”促使检查者查看4个脑室，最后“Bad”提醒检查者评估颅骨。
对5家机构的83名住院医师进行了初步检查。在标准化预测试中，课程开始前的平均正确百分比为60%（95%置信区间[CI]58%-64%）。在课程结束3个月后的重新测试中，准确率提高到了78%（n=61，95%CI 75%-81%，配对t检验P<.001）。
急诊医学住院医师解读头颅CT扫描的能力存在不足。一项新型教育课程被证明能显著提高这种能力。
