Sensitivity and Specificity of Emergency Physicians and Trainees for Identifying Internally Concealed Drug Packages on Abdominal Computed Tomography Scan: Do Lung Windows Improve Accuracy?
BACKGROUND
Suspected body packers may be brought to emergency departments (EDs) close to international airports for abdominal computed tomography (CT) scanning. Senior emergency clinicians may be asked to interpret these CT scans. Missing concealed drug packages have important clinical and forensic implications. The accuracy of emergency clinician interpretation of abdominal CT scans for concealed drugs is not known. Limited evidence suggests that accuracy for identification of concealed packages can be increased by viewing CT images on "lung window" settings.


OBJECTIVE
To determine the accuracy of senior emergency clinicians in interpreting abdominal CT scans for concealed drugs, and to determine if this accuracy was improved by viewing scans on both abdominal and lung window settings.


METHODS
Emergency clinicians blinded to all patient identifiers and the radiology report interpreted CT scans of suspected body packers using standard abdominal window settings and then with the addition of lung window settings. The reference standard was the radiologist's report.


RESULTS
Fifty-five emergency clinicians reported 235 CT scans. The sensitivity, specificity, and accuracy of interpretation using abdominal windows was 89.9% (95% confidence interval [CI] 83.0-94.7), 81.9% (95% CI 73.7-88.4), and 86.0% (95% CI 81.5-90.4), respectively, and with both window settings was 94.1% (95% CI 88.3-97.6), 76.7% (95% CI 68.0-84.1), 85.5% (95% CI 81.0-90.0), respectively. Diagnostic accuracy was similar regardless of the clinician's experience. Interrater reliability was moderate (kappa 0.46).


CONCLUSIONS
The accuracy of interpretation of abdominal CT scans performed for the purpose of detecting concealed drug packages by emergency clinicians is not high enough to safely discharge these patients from the ED. The use of lung windows improved sensitivity, but at the expense of specificity.
Emergency Department, St George Hospital, Kogarah, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
Stephen Edward
SE
Asha
Emergency Department, St George Hospital, Kogarah, New South Wales, Australia.
Andrew
A
Cooke
D001315:Australia; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D064423:Drug Trafficking; D004635:Emergency Medicine; D005547:Foreign Bodies / Q000000981:diagnostic imaging*; D006801:Humans; D013287:Illicit Drugs; D011237:Predictive Value of Tests; D011860:Radiography, Abdominal / Q000379:methods*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D013287:Illicit Drugs
X-ray; computed tomography; emergency medicine; foreign bodies; sensitivity and specificity; street drugs