Objectives: Cranial computed tomography (CT) is replacing skull radiography in head trauma. Rapid radiological opinions on these images may not always be available. We assessed the ability of our permanent emergency department staff to interpret the images. Methods: A retrospective series of 100 consecutive cases was reviewed and interpreted by five permanent emergency department medical staff, and their interpretation compared with the consensus opinion of two radiologists.Results: An overall agreement of 86.6% (95% confidence interval (CI) 83.4 to 89.9) was achieved, with a false negative rate of 4.2% (95% CI 3.9 to 4.3). No findings that would have changed the overnight management of any patient were missed. Conclusions: Our results for CT scans are similar to studies of interpretation of other radiographic images in emergency departments. Our emergency staff could safely make the initial interpretation of cranial CT images in trauma out of hours, and formal reporting may wait until a suitably experienced radiologist is available. D iscrepancies in plain radiograph interpretation between emergency department (ED) staff and radiologists have been the subject of study by various groups. [1][2][3][4][5][6] Rates of disagreement in the range of 8-11% are reported; however, many of the misinterpretations have no clinical impact. 4 Initial interpretation of plain radiographs by ED staff, supported by subsequent radiologist reports, has been standard practice for many years. Differences in the interpretation of computed tomography (CT) head scans between clinicians and neuroradiologists have also been investigated. Mehta et al showed a disagreement between clinicians and neuroradiologists in over 20% of cases and suggested that management change would be seen in 6.6%. 7 Similarly, Alfaro et al found discordance in 38.7% of cases, in 11.4% of which the disagreement was major.8 This study was not confined to trauma cases, and the timescale in management change was not significant in most cases. They concluded that mismanagement due to clinicians' opinion of the images is rare.Recent clinical guidelines in the UK from the National Institute of Clinical Excellence 9 (NICE) and the Scottish Intercollegiate Guidelines Network 10 (SIGN) promote the widespread use of cranial CT in head injury, with skull radiographs being relegated to a few specialist uses. This will result in a large increase in the number of cranial CT scans performed. The NICE guidelines state that image interpretation should be carried out by a ''competent clinician'', but who this should be is not stated. In this study we ask whether ED staff could make the initial interpretation of these images in the same way as they do for plain radiographs, or if this would result in serious missed diagnoses, which would alter immediate management.
METHODSAll out of hours CT scans performed in our hospital are recorded by our computerised radiology management system and a manual paper record kept by the radiographers. These records and the radiology request forms w...
Malignant phaeochromocytoma is a rare tumour and experience in its management is therefore limited. Five patients are discussed in whom the development of metastases was associated with rapidly progressive disease.
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