Do emergency physicians and radiologists reliably interpret pelvic radiographs obtained as part of a trauma series?
- 1Department of Radiology, Royal Bournemouth and Christchurch Hospitals, Bournemouth, UK
- 2Department of Nuclear Medicine, Guy's and St Thomas' Hospital, London, UK
- 3Department of Emergency Medicine, Royal Alexandra Hospital, Paisley, UK
- 4Department of Emergency Medicine, Greater Sydney Area HEMS Ambulance Service of NSW, Liverpool Hospital, Sydney, Australia
- 5Department of Emergency Medicine and Pre-hospital Care, London HEMS, The Royal London Hospital, London, UK
- Correspondence to Dr C Bent, Department of Radiology, Royal Bournemouth Hospital and Christchurch Hospitals, Castle Lane East, Bournemouth, Dorset BH7 7DW, UK;
Contributors CB, KH and TH designed the study. KH designed the templates and performed the original literature search. CB sourced the plain film images, the radiology reports on both plain films and CT studies, and formed the power point test series. CB administered the study to radiology at the Royal London Hospital, TH administered the study to emergency medicine at the Royal London Hospital, AN administered the study at St Thomas' emergency medicine department and SC at St Thomas's emergency department. Results were collated by TH using Microsoft Excel and the statistical analysis was performed by a professional statistician working with CB. All authors contributed to the writing of the paper but the bulk of the manuscript was prepared by SC. SC was responsible for submission. SC, CB and TH responded to reviewers' questions.
- Accepted 6 February 2012
- Published Online First 12 March 2012
Introduction Interpretation of pelvic radiography is an important component of the primary survey and is commonly performed by emergency physicians. Radiologists bring unique skills to trauma care, including choice of imaging modality and image interpretation. It is not clear if this limited resource is most efficiently used in the resuscitation room. No studies have compared radiologists and trauma clinicians in their ability to interpret pelvic radiographs following trauma.
Objective To determine the sensitivity and specificity of trauma experienced and trauma inexperienced emergency physicians in detecting pelvic fractures compared with radiologists, the latter subgroup combined report being used as the gold standard.
Setting and methods Prospective cohort study conducted in two large teaching hospitals in central London. All participants reviewed 144 consecutive pelvic radiographs performed each as part of a ‘trauma series’ and known to have undergone concomitant pelvic CT imaging.
Results No statistically significant difference was found between radiologists and emergency physicians from a trauma centre in pelvic radiograph interpretation. Radiologist reporting was associated with an improved specificity compared with emergency physicians working in a non-trauma hospital (p=0.049). The study population missed 30% of fractures on plain radiography against the gold standard of CT.
Discussion The ability to interpret trauma series pelvic radiographs is comparable between emergency physicians and radiologists. If this were also true of trauma chest radiographs, then the most valuable use of the radiologist may not be the resuscitation room but in rapid reporting of more complex imaging techniques. However, plain radiography is insensitive for pelvic fracture detection compared with CT, even in expert hands.
Competing interests None.
Ethics approval The study was reviewed by the chair of the local research and ethics committee. As there were no patients involved, and no medications or interventions, and the purpose of the project was to compare current department practice against a gold standard to assess reporting quality, no formal IRAS application was required.
Provenance and peer review Not commissioned; externally peer reviewed.