Shahram Bagheri-Hariri1, Niloofar Ayoobi-Yazdi2, Mo Afkar3, Shervin Farahmand4,5, Mona Arbab6, Neda Shahlafar3, Hamed Basirghafoori7, Seyedhosien Seyedhoseini-Davarani1, Mojtaba Sedaghat8, Atoosa Akhgar1. 1. Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran. 2. Clinical Radiology Department, Tehran University of Medical Sciences, Tehran, Iran. 3. Tehran University of Medical Sciences, Tehran, Iran. 4. Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran. shfarahmand@tums.ac.ir. 5. Emergency Department, Imam Khomeini Complex Hospital, Keshavarz Blvd., Tehran, 1419733141, Iran. shfarahmand@tums.ac.ir. 6. Harvard Medical School, Boston, MA, USA. 7. Emergency Medicine Department, Iran University of Medical Sciences, Tehran, Iran. 8. Community Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
Abstract
PURPOSE: In this study, the impact of contrast-enhanced abdominopelvic CT scan interpretations by emergency medicine team on patients' morbidity and mortality was evaluated and their interpretations were compared to radiologists' reports. METHODS: During a 3-month period, all patients who had undergone a contrast-enhanced abdominopelvic CT scan at the emergency department enrolled in this study. All CT scans were interpreted blindly by the emergency medicine (ED) attending physicians and the patients were treated accordingly. Radiologists reported all the CT scans within 12 h. Radiologists' reports were put into the agreement or disagreement group retrospectively. A panel of experts further evaluated the disagreement groups' medical charts and placed them in clinically significant or insignificant group based on the follow-up for 28 days. RESULTS: In this study, 170 CT scans were interpreted. The agreement rate was 68.2%. In the clinically significant disagreement group, eight patients did not receive the required treatment and three patients were over treated. Although the overall mortality rate was 5, none could have been prevented by a prompt radiologist's report. The disagreement group had longer hospital stay (p = 0.006) and transfer to other wards (p = 0.035). The inter-rater reliability between emergency medicine attending physicians and attending radiologists was substantial (kappa = 0.77) and statistically significant (p < 0.0001). CONCLUSION: Our findings support the cautious use of ED physicians' CT scan interpretations for patients' management. Ideally, the ED physicians should utilize a real-time radiologist interpretation in critical patients. This collaboration will result in better patient management.
PURPOSE: In this study, the impact of contrast-enhanced abdominopelvic CT scan interpretations by emergency medicine team on patients' morbidity and mortality was evaluated and their interpretations were compared to radiologists' reports. METHODS: During a 3-month period, all patients who had undergone a contrast-enhanced abdominopelvic CT scan at the emergency department enrolled in this study. All CT scans were interpreted blindly by the emergency medicine (ED) attending physicians and the patients were treated accordingly. Radiologists reported all the CT scans within 12 h. Radiologists' reports were put into the agreement or disagreement group retrospectively. A panel of experts further evaluated the disagreement groups' medical charts and placed them in clinically significant or insignificant group based on the follow-up for 28 days. RESULTS: In this study, 170 CT scans were interpreted. The agreement rate was 68.2%. In the clinically significant disagreement group, eight patients did not receive the required treatment and three patients were over treated. Although the overall mortality rate was 5, none could have been prevented by a prompt radiologist's report. The disagreement group had longer hospital stay (p = 0.006) and transfer to other wards (p = 0.035). The inter-rater reliability between emergency medicine attending physicians and attending radiologists was substantial (kappa = 0.77) and statistically significant (p < 0.0001). CONCLUSION: Our findings support the cautious use of ED physicians' CT scan interpretations for patients' management. Ideally, the ED physicians should utilize a real-time radiologist interpretation in critical patients. This collaboration will result in better patient management.
Entities:
Keywords:
Abdomen and pelvic CT scan; CT scan reports; Emergency department
Authors: Wytze Laméris; Adrienne van Randen; Marcel G W Dijkgraaf; Patrick M M Bossuyt; Jaap Stoker; Marja A Boermeester Journal: BMC Emerg Med Date: 2007-08-06