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Emerg Radiol (2015) 22:261268 DOI 10.1007/s10140-014-1279-0
ORIGINAL ARTICLE
Comparing the brain CT scan interpretation of emergency medicine team with radiologists report and its impact on patients outcome
Mohammad-Taghi Talebian & Elahe Kavandi & Shervin Farahmand &
Neda Shahlafar & Mona Arbab & Seyedhossein Seyedhosseini-Davarani &
Amir Nejati & Shahram Bagheri-Hariri
Received: 8 July 2014 /Accepted: 15 October 2014 /Published online: 30 October 2014 # American Society of Emergency Radiology 2014
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.
Keywords Cranial CTscan interpretation . Emergency medicine . Outcome
Introduction
Non-enhanced cranial computed tomograph (CT) scan is a crucial diagnostic tool in emergency departments as it could be used to diagnose patients with head trauma and serious illnesses [1]. According to the estimation of the National Center for Injury Prevention and Control, in any given year,1.7 million Americans suffer from traumatic brain injury and...