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Diagnostic uncertainty and physician experience
We commonly use chest x-ray (CXR) to diagnose community-acquired pneumonia (CAP) in the Emergency Department. The 2015 ESCAPED study found that in patients without parenchymal infiltrates on CXR, routine thoracic CT scan was positive for CAP in 33% of patients and in those that had a ‘positive’ CXR, CT scan excluded CAP in 29.8%. In this months ‘Editors Choice’, the authors have gone on to assess the impact of early CT thorax on the diagnostic certainty of Emergency Physicians. Not surprisingly, the clinician’s diagnosis was strongly influenced by the radiology report. What is more interesting is that the diagnosis and treatment plan were more likely to be changed by less experienced physicians (<10 years EM experience), not because of a worse pre-CT classification, but to a more accurate diagnosis as assessed by an independent adjudication committee. The authors hypothesise this may be due to influence by a more senior reporter, appreciation of technology in clinical practice, or better acceptance of a diagnostic test which differs from normal practice.
Pre-hospital termination of resuscitation rules
In the UK, the majority of paramedics are required to continue active resuscitation …