title: Diagnostic accuracy of lower extremity X-ray interpretation by 'specialized' emergency nurses.
abstract: OBJECTIVE
  In the quest for a cost-effective and quality-preserving solution to manage crowding in the emergency department, the possibility of deploying regular emergency nurses for the treatment of acute ankle injuries was investigated. The aim of this study is to compare the diagnostic accuracy of emergency nurses with that of senior house officers in interpreting ankle and foot radiographs.
  
  
  METHODS
  A prospective study comparing the assessment of 60 radiographs (30 feet and 30 ankles) by 16 emergency nurses before and after an educational session was performed. Each subset of 30 radiographs contained 12 fractures, hand-picked by a radiologist to represent everyday traumatology in the emergency department. The control group consisted of eight senior house officers representing everyday expertise. The outcome of the diagnostic assessment, represented as the pooled sensitivity and specificity for both groups, was compared using Z-statistics.
  
  
  RESULTS
  Before the training session, the specialized emergency nurse group showed a sensitivity of 0.87 (confidence interval 0.83-0.91) compared with 0.93 (confidence interval 0.88-0.96) for the control group (P = 0.05). The specificity of specialized emergency nurses was 0.87 (confidence interval 0.81-0.92) compared with 0.93 (confidence interval 0.89-0.95) for the senior house officers (P < 0.05). After the training session, specialized emergency nurse diagnostic parameters did not differ significantly from the control group, displaying a sensitivity of 0.89 (confidence interval 0.86-0.92) and specificity of 0.92 (confidence interval 0.87-0.95).
  
  
  CONCLUSIONS
  Before the training session, the specialized emergency nurse group showed a significantly lower accuracy than the SHO group. After training, however, the diagnostic accuracy did not differ significantly between groups. Therefore, we conclude that emergency nurses are able to accurately interpret foot and ankle radiographs after a short educational session.
authors.affiliation: Department of Surgery/Traumatology, VU University Medical Centre Amsterdam, The Netherlands. RJ.Derksen@VUmc.nl
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Derksen
authors.forename: Fred C
authors.initials: FC
authors.lastname: Bakker
authors.forename: Emil A
authors.initials: EA
authors.lastname: Heilbron
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Geervliet
authors.forename: Irma M
authors.initials: IM
authors.lastname: Spaans
authors.forename: Elly S M
authors.initials: ES
authors.lastname: de Lange-de Klerk
authors.forename: Bart
authors.initials: B
authors.lastname: Veenings
authors.forename: Peter
authors.initials: P
authors.lastname: Patka
authors.forename: Henk J Th M
authors.initials: HJ
authors.lastname: Haarman
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging*; D004506:Education, Nursing; D016529:Emergency Nursing / Q000592:standards*; D004636:Emergency Service, Hospital; D006801:Humans; D007318:Inservice Training; D007396:Internship and Residency / Q000592:standards*; D009426:Netherlands; D024802:Nurse's Role; D009733:Nursing Diagnosis / Q000592:standards*; D011446:Prospective Studies; D011859:Radiography; D013180:Sprains and Strains / Q000175:diagnosis