title: Comparing the brain CT scan interpretation of emergency medicine team with radiologists' report and its impact on patients' outcome.
abstract: Requesting non-enhanced brain CT scans for trauma and non-trauma patients in ER is very common. In this study, the impact of incorrect brain CT scan interpretations by emergency medicine team on patients' primary and secondary outcome was evaluated in the setting where neuroradiologist reports are not always available. During a 3-month period, 450 patients were enrolled and followed for 28 days. All CT scans were interpreted by the emergency medicine team, and the patients were managed accordingly. Neuroradiologists' reports were considered as gold standard, and the patients were then grouped into the agreement or disagreement group. A panel of experts further evaluated the disagreement group and placed them in clinically significant and insignificant. The agreement rate between emergency medicine team and neuroradiologists was 86.4 %. The inter-rater reliability between emergency team and neuroradiologists was substantial (kappa = 0.68) and statistically significant (p < 0.0001). Only five patients did not receive the necessary management, and among them, only one patient died, and 12 patients received unnecessary management including repeated CT scan, brain MRI, and lumbar puncture. Forty-one patients were managed clinically appropriate in spite of misinterpretation. A 28-day follow-up showed a mortality rate of 0.2 %; however, expert panel believed the death of this patient was not related to the CT scan misinterpretation. We conclude that although the disagreement rate in this study was 13.6 %, primary and secondary outcomes were not clinically jeopardized according to the expert panel idea and 28-day follow-up results.
authors.affiliation: Emergency Medicne Department, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad-Taghi
authors.initials: MT
authors.lastname: Talebian
authors.forename: Elahe
authors.initials: E
authors.lastname: Kavandi
authors.forename: Shervin
authors.initials: S
authors.lastname: Farahmand
authors.forename: Neda
authors.initials: N
authors.lastname: Shahlafar
authors.forename: Mona
authors.initials: M
authors.lastname: Arbab
authors.forename: Seyedhossein
authors.initials: S
authors.lastname: Seyedhosseini-Davarani
authors.forename: Amir
authors.initials: A
authors.lastname: Nejati
authors.forename: Shahram
authors.initials: S
authors.lastname: Bagheri-Hariri
mesh_terms: D001927:Brain Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000628:therapy; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed