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Influence of residency discipline and seniority on traumatic musculoskeletal radiographs interpretation accuracy: a multicenter study

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Objectives

Imaging studies are a significant and integral part of the initial assessment of patients admitted to the emergency department. Developing imaging diagnostic abilities early in residency is of paramount importance. The purpose of this study was to evaluate and compare diagnosis accuracy of common musculoskeletal X-rays (XR) between residency disciplines and seniority.

Methods

A multicenter study which evaluated orthopedic surgery, emergency medicine (EM), and radiology residents, through a test set of common MSK XR. Residents were classified as “beginner” or “advanced” according to postgraduate year per residency. Residents were asked to answer whether the radiograph shows normal or pathological findings (success rate) and what is the diagnosis (“diagnosis accuracy”). Residents’ answers were analyzed and assessed compared to experts’ consensus.

Results

A total of 100 residents (62% beginners) participated in this study. Fifty-four were orthopedic surgeons, 29 were EM residents and 17 were radiologists. The entire cohort’s overall success rate was 88.5%. The overall mean success rates for orthopedic, EM, and radiology residents were 93.2%, 82.8%, and 83.3%, respectively, and were significantly different (p < 0.0001). Orthopedic residents had significantly higher diagnostic accuracy rates compared with both radiology and EM residents (p < 0.001). Advanced orthopedic and EM residents demonstrated higher diagnostic accuracy rates compared to beginner residents (p = 0.001 and p = 0.03, respectively).

Conclusion

Orthopedic residents presented higher diagnosis accuracy of MSK imaging compared to EM and radiology residents. Seniority had a positive effect on diagnosis accuracy. The development of an educational program on MSK XR is necessary to enhance the competency of physicians in their daily practice.

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Data availability

Data are available at reasonable request from the corresponding author.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Shai Factor and Assaf Albagli are equal contributors as the first author.

Authors and Affiliations

  1. Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel

    Shai Factor, Assaf Albagli, Alex Bebin & Ittai Shichman

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Shai Factor, Assaf Albagli, Alex Bebin, Ido Druckmann & Ittai Shichman

  3. Division of Radiology, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel

    Ido Druckmann

  4. Division of Orthopedics, Soroka University Medical Center, Beer-Sheva, P.O. Box 151, 84101, Beer-Sheva, Israel

    Shlomi Bulkowstein

  5. Affiliated to the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

    Shlomi Bulkowstein

  6. Division of Orthopedic Surgery, Rambam Healthcare Campus, 3109601, Haifa, Israel

    Ido Stahl

  7. Affiliated to the Rappaport Faculty of Medicine, Technion-Israeli Institute of Technology, Haifa, Israel

    Ido Stahl

Authors
  1. Shai Factor
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Contributions

All authors that have contributed to this manuscript have agreed on the final revised version of this manuscript.

Corresponding author

Correspondence to Shai Factor.

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IRB approval

0972-20-TLV Helsinki Committee Approval date: 21.04.2021.

Appendix 1: Musculoskeletal x-rays pathologies and ICD-10 codes used in the test-set of the present study

Appendix 1: Musculoskeletal x-rays pathologies and ICD-10 codes used in the test-set of the present study

Anatomical region

Pathology

ICD-10 code

Foot

Fracture of calcaneus

S92.0

 

Fracture of talus

S92.1

 

Fracture of other tarsal bone(s)

S92.2

 

Fracture of metatarsal bone

S92.3

 

Dislocation of other and unspecified parts of foot  

S93.3

Ankle

Fracture of lower end of tibia

S82.3

 

Fracture of medial malleolus

S82.5

 

Fracture of lateral malleolus

S82.6

 

Dislocation of ankle joint  

S93.0

Shoulder

Fracture of clavicle

S42.0

 

Fracture of scapula

S42.1

 

Fracture of upper end of humerus

S42.2

 

Dislocation of shoulder joint

S43.0

Knee

Fracture of lower end of femur

S72.4

 

Fracture of patella

S82.0

 

Fracture of upper end of tibia

S82.1

 

Dislocation of knee

S83.1

Pelvis

Fracture of neck of femur

S72.0

 

Pertrochanteric fracture

S72.1

 

Dislocation of hip

S73.0

 

Fracture of acetabulum

S32.4

Wrist

Fracture of lower end of radius

S52.5

 

Fracture of navicular [scaphoid] bone of hand

S62.0

 

Fracture of other carpal bone(s)

S62.1

 

Fracture of other metacarpal bone

S62.3

 

Dislocation of wrist

S63.0

Elbow

Fracture of upper end of ulna

S52.0

 

Coronoid process\Elbow NOS\Monteggia fracture-dislocation\Olecranon process

 
 

Fracture of upper end of radius

S52.1

 

Head\Neck\Proximal end

 
 

Dislocation of elbow

S53.1

  1. ICD-10 International Classification of Diseases

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Factor, S., Albagli, A., Bebin, A. et al. Influence of residency discipline and seniority on traumatic musculoskeletal radiographs interpretation accuracy: a multicenter study. Eur J Trauma Emerg Surg 49, 2589–2597 (2023). https://doi.org/10.1007/s00068-023-02347-0

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