IMPACT OF CLINICAL HISTORY ON RADIOGRAPHIC DETECTION OF FRACTURES - A COMPARISON OF RADIOLOGISTS AND ORTHOPEDISTS
IMPACT OF CLINICAL HISTORY ON RADIOGRAPHIC DETECTION OF FRACTURES - A COMPARISON OF RADIOLOGISTS AND ORTHOPEDISTS
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DOI：
10.2214/ajr.153.6.1221
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发表时间：
1989-12-01
影响因子：
5
通讯作者：
ELKHOURY, GY
中科院分区：
文献类型：
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作者：
BERBAUM, KS;FRANKEN, EA;ELKHOURY, GY
放射科医师在解释影像学检查时所使用的方法是否与主治医师不同？我们评估了骨外科医生定位临床体征的知识对骨折检测准确性的影响，并将结果与早期放射科医生进行的相同研究的结果进行了比较。研究中的骨科医生与放射科医生具有相同程度的经验。由7名骨科医生对40张四肢X线片进行了两次检查。在26例病例中，存在细微骨折; 14例正常。在每例病例的X线片的一次解读中，提供了疼痛、压痛或肿胀的精确位置;在另一次解读中，保留了这些信息。对受试者操作特征参数的分析表明，关于创伤位置的线索有助于骨科医生检测骨折（A2改善11%，ROC曲线下面积，F[，12] = 49.67，p <0.001）。这一发现与早期放射科医生研究的结果相似（A2，F[1，12] - 14.77，p < .005）。两个实验的统计学比较表明，骨科医生比放射科医生更依赖这些信息，这一点通过统计学上显著的特殊交互作用（F[1，12] = 15.3，p <0.05）得到了证明。定位线索提高了骨科医生发现创伤患者骨折的能力，甚至超过了放射科医生的能力。当定位线索不可用时，放射科医生的准确性将比骨科医生的准确性受到更小的影响。尽管如此，研究结果表明，在寻找骨折时，定位线索对骨科医生和放射科医生都很重要。
Are the methods used by radiologists in interpreting imaging studies different from those of attending physicians? We evaluated the influence that knowledge of localizing clinical signs has on the accuracy of fracture detection by orthopedic surgeons and compared the results with those of an identical study of radiologists performed earlier. The orthopedists studied had the same degree of experience as the radiologists. Forty radiographs of the extremities were examined twice by seven orthopedic surgeons. In 26 cases, a subtle fracture was present; 14 cases were normal. During one interpretation of the radiographs of each case, the precise location of pain, tenderness, or swelling was provided; during the other, this information was withheld. Analysis of receiver-operating-characteristic parameters indicates that the clues regarding location of trauma facilitate detection of fractures by orthopedists (an 11% improvement in A2, the area under the ROC curve, F[,12] = 49.67, p < .001). This finding is similar to the results of the earlier study with radiologists (a 6% improvement in A2, F[1,12] - 14.77, p < .005). Statistical comparison of the two experiments showed that orthopedists depend on this information much more than do radiologists, demonstrated by a statistically significant prompting-by-specially interaction (F[1,12] = 15.3, p < .05). Localization clues improve ability of orthopedic surgeons to detect fractures in the trauma patient even more than they improve the ability of radiologists. The accuracy of the radiologist will suffer less than that of the orthopedist when localization clues are unavailable. Nonetheless, the findings show that localizing clues are important to both orthopedists and radiologists when searching for fractures.