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Comparing the Brain Ct Scan Interpretation of Emergency Medicine Team With Radiologists’ Report and Its Impact on Patients’ Outcome Publisher Pubmed



Talebian MT1 ; Kavandi E1 ; Farahmand S1 ; Shahlafar N2 ; Arbab M3 ; Seyedhosseinidavarani S1 ; Nejati A4 ; Bagherihariri S1, 5
Authors
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Authors Affiliations
  1. 1. Emergency Medicne Department, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Radiology Department, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Massachusetts General Hospital, Harvard Medical School, Boston, United States
  4. 4. Prehospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Emergency Medicine Department, Tehran University of the Medical Sciences, Keshavarz Boulevard. Imam Khomeini Complex Hospital, Tehran, 1419733141, Iran

Source: Emergency Radiology Published:2015


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. © 2014, American Society of Emergency Radiology.