Study supports the use of general radiologists during off hours
A general radiologist can be a good, first line of defense in the evaluation of emergency CT scans during off hours, when neuroradiologists are unavailable, a recent study shows.
As a way to evaluate the accuracy of general radiologists in emergency rooms, William K. Erly, MD, assistant professor of radiology at The University of Arizona and lead author of the study, along with his colleagues, studied 716 consecutive emergency head CT examinations, which were interpreted by one of 15 on-call general radiologists and then again by a neuroradiologist the following day. The study involved 96% of the acute care hospital beds covered by private practice radiologists in Tucson, AZ.
According to the study, the general radiologist and the final neuroradiologist interpretations were in agreement on 95% of studies, insignificant disagreement on 3%, and significant disagreement on 2%. The CT examinations included in the study involved a mix of patients including stroke, car accident, and other head-trauma victims, says Dr. Erly.
As for the discrepancy in readings, Dr. Erly says, "In no instance was there a critically adverse outcome." However, supporting the idea that sometimes two are better than one when it comes to reading emergency CT scans, Dr. Erly says, "If a neuroradiologist had not looked at the scans, there could have been worse outcomes than there were."
Dr. Erly adds, "I don't know how neuroradiologists would do if they were up all night reading either. It's my guess that neuroradiologists would miss things as well." Although his study did not record the times at which general radiologists read the scans, Dr. Erly thinks it would be interesting to see how time affected the performance of general radiologists and says, "I think a lot of the misses were due to the fact that the films were read in the middle of the night."
Dr. Erly says he and his colleagues plan to further examine how neuroradiologists perform under the same conditions, by having neuroradiologists over-read other neuroradiologists. He says preliminary results appear to be similar, with about a 1% miss rate for neuroradiologists, compared to 2% for general radiologists.
The study will be presented May 7, during the American Roentgen Ray Society Annual Meeting in San Diego.