Abdominal and pelvic CT scan interpretation of emergency medicine physicians compared with radiologists' report and its impact on patients' outcome.

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.

Comparing the brain CT scan interpretation of emergency medicine team with radiologists' report and its impact on patients' outcome.

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.

The impact of using RUSH protocol for diagnosing the type of unknown shock in the emergency department.

Clinical assessment and classification of shock is extremely difficult to conduct on critically ill patients especially upon arrival at the emergency department. Resuscitative point-of-care ultrasound could be used for rapid initial diagnosis and better management. In this study, the results of using the RUSH (Rapid Ultrasound in Shock) exam to determine the type of shock in the emergency department are compared to the final diagnosis of patients. This was a single-center prospective study in which all patients with an unknown type of shock and no prior treatment were included. Parallel to the standard resuscitative management and diagnosis of the emergency team, the RUSH exam was performed blindly on the patient by an emergency medicine staff who was not part of the patient's caregiving team. The results of the RUSH exam were then compared to the final diagnosis of the patients and the 48-h outcome. Twenty-five patients were enrolled in this study. The overall kappa correlation of the RUSH exam compared with the final diagnosis was 0.84 which is an almost perfect agreement. The overall sensitivity of the RUSH exam was 88 % and the specificity was 96 %. Although the mortality rate was 64 %, there was not a significant relationship between mortality and the protocol used for diagnosis. The RUSH exam could be used in emergency wards to detect types of shock.