Radiologists' review of radiographs interpreted confidently by emergency physicians infrequently leads to changes in patient management
Radiologists' review of radiographs interpreted confidently by emergency physicians infrequently leads to changes in patient management
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DOI：
10.1016/s0196-0644(98)70307-5
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发表时间：
1998-02-01
影响因子：
6.2
通讯作者：
Brunette, DD
中科院分区：
文献类型：
--
作者：
Lufkin, KC;Smith, SW;Brunette, DD
研究目的：当急诊医生对他们的解释有信心时，确定放射科医生对X光片的审查是否是不必要的。在高容量的城市教学医院和中等容量的非教学医院治疗急诊科医生表示，他们的信心或缺乏信心，在他们的平片影像学研究的解释。然后由放射科医生根据每家医院的既有实践对所有X线片进行审查。共纳入了16，410项急诊科放射学研究，包括每家医院的连续患者。审查了置信组中所有不一致读数的图表，如果改变治疗，则判定其具有临床意义。收费的放射审查的信心艾德interpretations.Results：艾德医生有信心在9,599套的X光片的总数为16,410（58%）。“置信”和“不置信”组的不一致解释率分别为1.2%和3.1%（差异为1.9%;差异的95%置信区间[CI]为1.44%至2.36%）。对自信组中的118个不一致解释的审查表明，11个是显著的。由于放射科医师对这些X线片的审查，很少进行管理变更。自信组的总放射学检查费用为215338美元。结论：在本研究的9,599组急诊医生有信心解释的X线照片中，有11组有临床意义的不一致解释（0.1%）。放射科医师审查所有艾德X光片的标准做法可能是不合理的。
Study objective: To determine whether radiologists' review of radiographs is unwarranted when emergency physicians are confident in their interpretations.Methods: This was a prospective, descriptive study. Treating emergency physicians at a high-volume, urban teaching hospital and a moderate-volume nonteaching hospital indicated their confidence or lack of confidence in their plain-film radiographic study interpretations. All radiographs were then reviewed by radiologists according to the preexisting practice of each hospital. A total of 16,410 emergency department radiographic studies were included, comprising consecutive patients at each hospital. Charts of all discordant readings in the confident group were reviewed and judged clinically significant if treatment was altered. Charges for radiologic review of the confident ED interpretations were calculated.Results: The ED physicians were confident in 9,599 sets of radiographs out of a total of 16,410 (58%). Discordant interpretation rates for the "confident" and "not confident" groups were 1.2% and 3.1%, respectively (difference, 1.9%; 95% confidence interval [CI] of the difference, 1.44% to 2.36%). Review of the 118 discordant interpretations in the confident group demonstrated that 11 were significant. Few management changes were made as a result of radiologists' review of these radiographs. Total radiology review charges for the confident group were $215,338. Therefore the aver age radiology charge for each significant discordant interpretation was $19,576.Conclusion: Of 9,599 sets of radiographs interpreted confidently by the emergency physicians in this study, there were 11 clinically significant discordant interpretations (0.1%). The standard practice of radiologists' review of all ED radiographs may not be justifiable.