Abbreviated Educational Session Improves Cranial Computed Tomography Scan Interpretations by Emergency Physicians,☆☆,

Presented at the 1995 Society for Academic Emergency Medicine Annual Meeting, San Antonio, Texas.
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Abstract

Study objective: Previously published research (phase I) demonstrated a concerning misinterpretation rate of cranial computed tomography (CT) scans by emergency physicians. This study (phase II) determined whether an abbreviated educational session would improve emergency physician interpretation skills of cranial CT scans. Methods: Participants in this prospective, interventional study in a county hospital ED were patients undergoing cranial CT scanning during ED evaluations and attending level emergency physicians. An abbreviated educational session on cranial CT interpretation skills was given to the same attending emergency physicians who participated in phase I. The educational session included basic CT interpretation skills and misinterpreted CT scans from phase I. We determined the postsession accuracy rate of the emergency physicians on 324 ED patient CT scans. The CT interpretation accuracy rates were then compared between phase I and phase II to determine the effectiveness of the educational session. Results: The radiology/ED CT scan concordance rate improved from 61.3% (κ=.22) to 88.6% ( κ=.70; P<.0001). Potentially clinically significant CT scan misinterpretations decreased from 24.1% to 4.0% (P<.0001). Most importantly, major missed findings on CT scans decreased from 11.4% to 2.8% (P<.0001). Continuous quality improvement monitoring found no instance of clinically significant patient mismanagement. Conclusion: Within the limits of this study, we conclude that emergency physicians' interpretation skills of cranial CT scans may be improved using a 1-hour educational session. [Levitt MA, Dawkins R, Williams V, Bullock S: Abbreviated educational session improves cranial computed tomography scan interpretations by emergency physicians. Ann Emerg Med November 1997;30:616-621.]

Section snippets

INTRODUCTION

Cranial computed tomography (CT) scans are commonly ordered by emergency physicians in the evaluation of ED patients. It has been reported that radiologists are not available in many hospitals on a 24-hour basis for CT scan interpretations.1 Therefore it is important that emergency physicians develop interpretation skills for cranial CT scans as they have for plain radiographs.

Previously published research at this institution demonstrated a 38.7% misinterpretation rate of cranial CT scans by

MATERIALS AND METHODS

Highland General Hospital is the county medical facility with approximately 70,000 patient visits per year. This hospital supports a 4-year emergency medicine residency program. It is a Level II trauma center (there are no Level I centers in Alameda County, California). There are 10 full-time and 4 part-time faculty members, all of whom are emergency medicine residency trained, board certified in emergency medicine, and all of whom participated in both phases of the study. The entire study

RESULTS

A total of 879 scans on ED patients undergoing cranial CT were interpreted by 14 attending level emergency physicians during both phases. During phase I 555 CT scans were interpreted and 324 scans during phase II. Phase I patients were characterized by a mean age of 42.9±8.8 years and phase II patients by a mean age of 46.1±8.1 years (P=NS). The difference in gender distribution between phase I (35.7% female, 64.3% male subjects) and phase II (34.7% female, 65.3% male subjects) was not

DISCUSSION

Various aspects of clinical performance of physicians are constantly being evaluated. This is of obvious importance to ensure that quality health care is being delivered to patients. Our previous study tested the accuracy of emergency physicians in interpreting cranial CT scans.2 We demonstrated a 38.7% nonconcordance rate between emergency physicians and radiologists. The study was strict in definition of concordance in that the findings by both physicians had to match exactly. The study also

Acknowledgements

We thank Dr Jack Ellis for his continuous quality improvement review of the patients who were enrolled in this study and Jacquelyn Alejandrez for her help in manuscript preparation.

References (9)

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From the Departments of Emergency Medicine* and Radiology, Alameda County Medical Center—Highland Campus, Oakland, CA; and the Division of Emergency Medicine, University of California, San Francisco, San Francisco, CA§

☆☆

Reprint no. 47/1/85426

Address for reprints: M Andrew Levitt, DO, FACEP, Department of Emergency Medicine, Alameda County Medical Center–Highland Campus, 1411 East 31st Street, Oakland, CA 94602

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