Abstract
Requesting non-enhanced brain CT scans for trauma and non-trauma patients in ER is very common. In this study, the impact of incorrect brain CT scan interpretations by emergency medicine team on patients’ primary and secondary outcome was evaluated in the setting where neuroradiologist reports are not always available. During a 3-month period, 450 patients were enrolled and followed for 28 days. All CT scans were interpreted by the emergency medicine team, and the patients were managed accordingly. Neuroradiologists’ reports were considered as gold standard, and the patients were then grouped into the agreement or disagreement group. A panel of experts further evaluated the disagreement group and placed them in clinically significant and insignificant. The agreement rate between emergency medicine team and neuroradiologists was 86.4 %. The inter-rater reliability between emergency team and neuroradiologists was substantial (kappa = 0.68) and statistically significant (p < 0.0001). Only five patients did not receive the necessary management, and among them, only one patient died, and 12 patients received unnecessary management including repeated CT scan, brain MRI, and lumbar puncture. Forty-one patients were managed clinically appropriate in spite of misinterpretation. A 28-day follow-up showed a mortality rate of 0.2 %; however, expert panel believed the death of this patient was not related to the CT scan misinterpretation. We conclude that although the disagreement rate in this study was 13.6 %, primary and secondary outcomes were not clinically jeopardized according to the expert panel idea and 28-day follow-up results.
Similar content being viewed by others
References
Lal NR, Murray UM, Eldevik OP, Desmond JS (2000) Clinical consequences of misinterpretations of neuroradiologic CT scans by on-call radiology residents. AJNR Am J Neuroradiol 21(1):124–129
Kerr ZY, Harmon KJ, Marshall SW, Proescholdbell SK, Waller AE (2014) The epidemiology of traumatic brain injuries treated in emergency departments in North Carolina, 2010-2011. N C Med J 75(1):8–14
Alfaro D, Levitt MA, English DK, Williams V, Eisenberg R (1995) Accuracy of interpretation of cranial computed tomography scans in an emergency medicine residency program. Ann Emerg Med 25(2):169–174
Mucci B, Brett C, Huntley LS, Greene MK (2005) Cranial computed tomography in trauma: the accuracy of interpretation by staff in the emergency department. Emerg Med J 22(8):538–540
SPSS Inc. Released (2002) SPSS for Windows, Version 11.0. SPSS Inc, Chicago http://www-01.ibm.com/software/analytics/spss/
Arendts G, Manovel A, Chai A (2003) Cranial CT interpretation by senior emergency department staff. Australas Radiol 47(4):368–374
Arhami Dolatabadi A, Baratloo A, Rouhipour A, Abdalvand A, Hatamabadi H, Forouzanfar M, Shojaee M, Hashemi B (2013) Interpretation of computed tomography of the head: emergency physicians versus radiologists. Trauma Mon 18(2):86–89
Erly WK, Berger WG, Krupinski E, Seeger JF, Guisto JA (2002) Radiology resident evaluation of head CT scan orders in the emergency department. AJNR Am J Neuroradiol 23(1):103–107
Strub WM, Leach JL, Tomsick T, Vagal A (2007) Overnight preliminary head CT interpretations provided by residents: locations of misidentified intracranial hemorrhage. AJNR Am J Neuroradiol 28(9):1679–1682
Acknowledgments
Authors would like to show their deepest gratitude for those patients who willingly participate in the study and the 28-day follow-up. Authors would like to appreciate the effort that the expert panel made to the classifications and discussion sessions.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Talebian, MT., Kavandi, E., Farahmand, S. et al. Comparing the brain CT scan interpretation of emergency medicine team with radiologists’ report and its impact on patients’ outcome. Emerg Radiol 22, 261–268 (2015). https://doi.org/10.1007/s10140-014-1279-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10140-014-1279-0