How good are emergency department Senior House Officers at interpreting X-rays following radiographers' triage?
OBJECTIVE
To assess the accuracy of Senior House Officers at interpreting plain X-rays following their triage by radiographers in an emergency department.


METHODS
We collected 2593 patients' records by systematic sampling of all those seen by emergency physicians between January 2002 and April 2002 (ca 10 000 patients) in a UK emergency department. The variables recorded included evidence of X-ray investigations and, when present, the Senior House Officer's diagnosis, the presence (abnormal) or absence of a radiographers red dot and the reference standard diagnosis. A separate category of uncertain (inconclusive) was applied to the Senior House Officer and reference standard diagnosis where appropriate. Diagnostic performance was measured by likelihood ratios with associated pre-test and post-test probabilities.


RESULTS
Including the uncertain category as abnormal gave the following results: there were 967 X-rays and those with a red dot had a probability of an abnormality of 80%. Although a further opinion of abnormal by a Senior House Officer increased this probability to 89% when they overrode the red dot opinion of the radiographer, it was incorrect in 26% of cases.


CONCLUSIONS
Currently, the Senior House Officer contributes to the red dot system by improving on the radiographer in rates of diagnosis of both abnormal and normal X-rays. Further reductions in error rates, however, are unlikely to be achieved until there is a change to the existing system. This may ultimately involve removing some of the responsibility of X-ray interpretation from the Senior House Officer. Any future research should consider the methodological issues highlighted by this study.
Willis
Brian H
BH
Emergency Department, Horton Hospital, Oxford Radcliffe Hospitals NHS Trust, Oxon, UK. b.h.willis@doctors.org.uk
Sur
Shyamaly D
SD
D002983:Clinical Competence; D003951:Diagnostic Errors / Q000517:prevention & control*; D004635:Emergency Medicine / Q000592:standards*; D004636:Emergency Service, Hospital; D006801:Humans; D008505:Medical Staff, Hospital / Q000592:standards*; D015588:Observer Variation; D011859:Radiography / Q000592:standards*; D011872:Radiology Department, Hospital; D012015:Reference Standards; D012680:Sensitivity and Specificity; D014218:Triage / Q000592:standards*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging