Accuracy of Brain Computed Tomography Diagnosis by Emergency Medicine Physicians

Abstract

Objectives: The objective of this study is to prospectively analyze emergency physicians' (EP's) abilities to interpret noncontrast computed tomography (NCCT) brain images in a blinded fashion and assess whether they can make medical decisions solely based on their interpretations.

Methods: A cross-sectional study was conducted at the emergency department (ED), King Saud University Medical City (KSU-MC), Saudi Arabia, over a period of one year, from May 2014 to May 2015. Any patient who underwent plain brain NCCT during the study period in our ED was included in this study. An independent attending neuroradiologist compared the EP's interpretations with the official final reports dictated by an on-call radiologist.

Results: A brain NCCT prospective chart audit of 1,524 patients was interpreted by ED physicians (EP) at KSU-MC from 2014-2015. The ages of patients were between 14 and 107 years, and the mean ± SD age was 45.6 ± 22.1 years. Radiological brain lesions were confirmed by EPs and radiology physicians in 230 (15.09) and 239 (15.68) patients, respectively, out of which concordance was observed in 170 (71.13) cases, with a kappa value of r = 0.675. Normal, chronic, and nil acute reports were made by EPs and radiology physicians for 1,295 (84.97) patients and 1,285 (84.32) patients, respectively, out of which concordance was observed in 1,225 (95.33) cases, with a kappa value of r = 0.672. The study results demonstrated that the overall agreement between EPs and radiologist specialists was 91.6, with a kappa value of .675 (p < 0.001).

Conclusion: Emergency physicians are moderately accurate at interpreting brain NCCT compared to radiologists. More research is needed to discover the most cost-effective technique for reducing the number of significant misinterpretations.