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首页> 外文期刊>Emergency radiology >Interpretation of head CT scans in the emergency department by fellows versus general staff non-neuroradiologists: a closer look at the effectiveness of a quality control program.
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Interpretation of head CT scans in the emergency department by fellows versus general staff non-neuroradiologists: a closer look at the effectiveness of a quality control program.

机译：研究员与普通职员非神经放射科医生对急诊科头部CT扫描的解释：仔细观察质量控制计划的有效性。

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Prior studies have evaluated discordance rates among radiology residents in interpretation of head computed tomograms (CTs). To our knowledge, there has been no study to compare performance among first-year fellows and more experienced general staff radiologists. This study will compare performances of these groups and evaluate the effect of a redundant system as part of a quality control program. Retrospective review of 3,886 consecutive head CTs in the Emergency Department from 7/01/04 to 6/30/2005 was performed. Fellows interpreted 2,150 and general staff radiologists 1,736 cases. Staff radiologist mean experience was 4 years (2-10 years). All primary interpretations were over-read by staff neuroradiologists (>10 years experience) as quality control. Discrepancies were divided into "major discordance" and "minor discordance." Major discordance is defined as a misread occurred that potentially delayed clinical management and thus may have incurred in mortality or disability. Minor discordance is defined as if there was no change in clinical management or impact on the patient's outcome. The patient electronic medical records were obtained and retrospectively reviewed to identify if there was an acute change in clinical management. Overall discordance rate of both groups was 2.7% (103/3,886), 0.3% major false negative (10/3,886), 1.7% minor false negative (65/3,886), 0.4% false positive (15/3,886). Fellows overall discordance rate was 2.6% (55/2,150) with major false negatives 4/2,150 (0.2%) and 2.8% (48/1,736) for general staff radiologists with 6/1736 (0.3%) major false negatives, p values 0.69 and 0.14, respectively. Three out of ten major false negatives were confirmed with the quality assurance interpretation on follow-up studies; four cases were in agreement with initial interpretation. Performance among first-year fellows and general staff radiologists in interpretation of head CTs was highly accurate (97.3%) without statistically significant difference between the groups. The overall relatively low discrepant rate between fellowship trainees and generalist staffs, as well as the negligible change in clinical management, suggests little utility in over-reads of head CT scans by the neuroradiology service as part of a year-round quality control program. However, because of a relative high discrepant rate in the early months of fellowship training (>5%) in our study, it may be wise to implement a quality assurance program in the first few months to improve patient care. Increasing over-reading rate may reduce false negative rate, as the overall false positive rate is relatively low (<0.5%).
机译：先前的研究已经评估了放射科住院医师在解释头颅计算机断层扫描（CT）时的不一致率。据我们所知，还没有研究可以比较一年级研究员和经验更为丰富的一般放射线医生的表现。这项研究将比较这些小组的表现，并评估作为质量控制计划一部分的冗余系统的效果。回顾性回顾了从04年7月1日至2005年6月30日的急诊科连续3,886例头部CT。研究员解释了2,150例，普通职员放射科医生解释了1,736例。放射线职员的平均经验为4年（2-10年）。工作人员的神经放射学家（> 10年的经验）已将所有主要解释都过分理解为质量控制。差异分为“重大不符”和“较小不符”。重大不符定义为误读，可能会延迟临床治疗，从而可能导致死亡或致残。轻微不和谐定义为临床管理没有改变或对患者预后没有影响。获得了患者电子病历并进行了回顾性审查，以确定临床管理是否发生了急性变化。两组的总体失格率分别为2.7％（103 / 3,886），0.3％严重假阴性（10 / 3,886），1.7％轻微假阴性（65 / 3,886），0.4％假阳性（15 / 3,886）。研究员的总体不一致率是2.6％（55 / 2,150），主要假阴性为4 / 2,150（0.2％），而一般职员放射科医生的总假阳性率为2.8％（48 / 1,736），主要假阴性为6/1736（0.3％），p值为0.69和0.14分别。后续研究的质量保证解释证实了十分之三的重大假阴性;有四个案例与初步解释相符。一年级研究员和一般放射线医师对头颅CT的解释非常准确（97.3％），两组之间无统计学差异。进修生与通才之间总体上相对较低的差异率，以及临床管理方面的微不足道的变化，表明作为全年质量控制计划的一部分，神经放射学服务对头部CT扫描的过度读取几乎没有用处。但是，由于在我们的研究中，奖学金研究的前几个月差异率较高（> 5％），因此在头几个月实施质量保证计划以改善患者护理可能是明智的。由于总体误报率相对较低（<0.5％），因此增加的过度阅读率可能会降低误报率。

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