title: The accuracy of adult limb radiograph interpretation by emergency nurse practitioners: A prospective comparative study.
abstract: BACKGROUND
  One of the extensions to practice for the emergency nurse practitioner role is to appropriately order and interpret radiographs in the emergency department.
  
  
  OBJECTIVE
  The aim of the study was to compare the accuracy in interpreting isolated adult limb radiographs between emergency nurse practitioners and emergency physicians.
  
  
  METHODS
  A prospective comparative study was undertaken.
  
  
  METHODS
  Emergency department in a large metropolitan hospital.
  
  
  METHODS
  200 adult patients with isolated limb injuries were consented.
  
  
  METHODS
  Six emergency nurse practitioners and ten emergency physicians participated. One emergency physician and emergency nurse practitioner independently clinically assessed each patient, determined the need for radiograph and separately recorded their interpretation of the radiograph as either definite fracture, no fracture or possible fracture. A single consultant radiologist reviewed each radiograph and their interpretation was seen as the gold standard. The sensitivity and specificity of emergency physicians and emergency nurse practitioners were calculated. To measure the level of agreement between the two-clinician groups, the weighted Kappa statistic was used.
  
  
  RESULTS
  The sensitivity for the emergency nurse practitioners was 91% and 88% for the emergency physicians. The specificity for the emergency nurse practitioners was 85% and for the emergency physicians 91%. The weighted Kappa on the presence of a fracture between the emergency nurse practitioners and emergency physicians was 0.83.
  
  
  CONCLUSIONS
  This study validates the clinical and diagnostic skills of emergency nurse practitioners assessed in the interpretation of isolated adult limb injury radiographs.
authors.affiliation: Florence Nightingale School of Nursing & Midwifery, King's College London, London, UK. Electronic address: Gerry.lee@kcl.ac.uk.
authors.forename: G A
authors.initials: GA
authors.lastname: Lee
authors.affiliation: Alfred Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Chou
authors.affiliation: Alfred Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Jennings
authors.affiliation: Alfred Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia.
authors.forename: G
authors.initials: G
authors.lastname: O'Reilly
authors.affiliation: Alfred Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia.
authors.forename: E
authors.initials: E
authors.lastname: McKeown
authors.affiliation: Alfred Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Bystrzycki
authors.affiliation: Department of Radiology, Alfred Hospital, Melbourne, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Varma
mesh_terms: D000328:Adult; D005121:Extremities / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011859:Radiography
keywords: Emergency nurse practitioner; Emergency physician; Quality; Radiographic interpretation