Pediatric emergency physician interpretation of plain radiographs : Is routine review by a radiologist necessary and cost-effective ?
To determine the concordance rate of plain radiograph interpretations by pediatric emergency physicians and pediatric radiologists, to evaluate the effect of incorrect radiologic diagnosis on patient management, and to evaluate the necessity and cost-effectiveness of routine follow-up review of all plain radiographs by a radiologist.
We assembled a prospective series of all patients who presented to the emergency department of an urban tertiary care children's hospital and underwent plain radiography between October 1 and October 31,1994.
Pediatric emergency physicians documented their interpretations.
Within 24 hours, films were reviewed by a pediatric radiologist.
The two interpretations were classified as concordant or discordant and were further assessed for medical significance and subsequent change in management.
During the study period, 707 radiographic examinations were performed :
chest, 56% ;
skeletal excluding spine, 20.1% ;
abdomen, 11.9% ;
sinus, 4.2% ;
spine, 3.6% ;
and other, 4%. The accuracy or concordance rate was 90.2% (638 of 707) for pediatric emergency physician interpretations ;
clinical management was unchanged in 96.9% (685 of 707) of the cases.
Of the 69 discordant interpretations, 48 were clinically significant, with 22 requiring changes in management.
They included 9 false-negative interpretations by pediatric emergency physicians : (5 fractures, 2 cases of pneumonia, 1 case of sinusitis, 1 c...
Mots-clés Pascal : Radiographie, Médecin, Pédiatrie, Urgence, Radiologue, Etude comparative, Interprétation, Analyse coût efficacité, Comparaison interindividuelle, Enfant, Homme, Prospective, Economie santé, Radiodiagnostic, Personnel sanitaire
Mots-clés Pascal anglais : Radiography, Physician, Pediatrics, Emergency, Radiologist, Comparative study, Interpretation, Cost efficiency analysis, Interindividual comparison, Child, Human, Prospective, Health economy, Radiodiagnosis, Health staff
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0190188
Code Inist : 002B24A10. Création : 199608.