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 Table of Contents  
EDITORIAL
Year : 2022  |  Volume : 12  |  Issue : 3  |  Page : 218-219

Emergency computed tomography scans in trauma: Where radiology is lacking the clinician fills the gap!


1 Department of Radiology, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Congella, Durban, South Africa
2 Trauma and Burn Service, Inkosi Albert Luthuli Central Hospital, Mayville; Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Congella, Durban, South Africa

Date of Submission30-Jul-2022
Date of Acceptance30-Jul-2022
Date of Web Publication15-Sep-2022

Correspondence Address:
Prof. Timothy Craig Hardcastle
Trauma and Burn Service, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Rd., Mayville, Durban; Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Congella, Durban
South Africa
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aihb.aihb_146_22

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How to cite this article:
Parag P, Hardcastle TC. Emergency computed tomography scans in trauma: Where radiology is lacking the clinician fills the gap!. Adv Hum Biol 2022;12:218-9

How to cite this URL:
Parag P, Hardcastle TC. Emergency computed tomography scans in trauma: Where radiology is lacking the clinician fills the gap!. Adv Hum Biol [serial online] 2022 [cited 2022 Sep 25];12:218-9. Available from: https://www.aihbonline.com/text.asp?2022/12/3/218/356107



Approximately 4.7 million people die each year due to trauma, accounting for 8.5% of global deaths and it is estimated that 973 million people suffer from injuries that warrant emergency medical attention every year.[1] Interpersonal violence and road traffic collisions are the chief contributors to the high rate of morbidity and mortality, particularly in low- and middle-income countries (LMICs). LMICs account for approximately 90% of all global cases of trauma-related mortality.[2]

Radiology department workloads have increased in recent years and the availability of radiologists is inadequate worldwide, particularly in in LMIC.[3] Resource restriction is a major concern for major trauma care in LMIC and time is of the essence in managing the trauma patient.

In severe trauma, radiology is the key to the early diagnosis and management of the injured patient. Computed tomography (CT) scanning is utilised as an important diagnostic tool in the assessment of trauma patients.[4] CT angiography is the initial diagnostic imaging examination of haemodynamically stable patients with suspected arterial injuries.[5] Traumatic brain injury and vascular injury are particularly time sensitive as life or limb are often at risk.

Emergency CT scans in trauma are usually interpreted by the attending doctor and plans to manage the patient are implemented before the formal radiological report is available. Timeous evaluation of the CT scan in trauma is crucial in managing the patient; given the high trauma burden and scarcity of radiologists in LMIC.

We investigated the discrepancy in the interpretation of emergency CT scans in head injury between the neurosurgeon and radiologist as well as the interpretation of CT angiograms in vascular trauma by the vascular surgeon and radiologist. The difference in surgeon and radiologist interpretation of emergency trauma CT scans was determined and the impact on patient management and outcome was assessed.

Out of 347 CT head scans, the neurosurgeons correctly interpreted 318 cases. Of the 29 incorrectly interpreted cases, there were 17 false negatives and 12 cases with mismatching abnormalities. The concordance rate was 91.64% (95% confidence interval [CI]: 88.73–94.55) with a kappa of 0.78. An accuracy rate of 95.33% (95% CI: 92.63–97.26) was achieved by the neurosurgeon. No patient was negatively impacted by any neurosurgical error in misinterpretation.

Out of 131 CT angiograms, the vascular surgeon correctly interpreted 120 out of 123 negative cases with three false positives. There were no false negatives or descriptive errors. A 100% sensitivity (95% CI 63.06–100) and 97.62% (95% CI: 93.20–99.51) specificity were noted for the vascular surgeon. Overall agreement was 97.71% with Cohen's kappa value = 0.83 (95% CI: 0.64–1.00) indicating very good agreement. No patient outcome was negatively impacted by the vascular surgeons' errors in interpretation.

We concluded that in the interpretation of CT head scans in trauma, there is good neurosurgical and radiological interobserver agreement without negative patient impact. The neurosurgeons' interpretation of CT scans of the head in TBI is safe, especially when radiology reports are not timeously available. There is a very good interobserver agreement in the interpretation of CT angiograms in trauma between the vascular surgeon and radiologist with no negative impact on patient outcome.

The neurosurgeon or vascular surgeon is concerned about identifying a lesion which may require urgent intervention and would easily fail to observe a non-critical finding that would not affect the management of the patient. For example, the neurosurgeon may not observe a 'simple linear skull fracture' on the CT scan and there would be no alteration in patient management or outcome. Furthermore, this does not reflect as a shortcoming on the part of the surgeon as long as critical findings are identified and timeous interventions are performed such as the evacuation of a subdural haematoma. The radiologist is closer to a 'purist' who is professionally compelled to reporting every identifiable abnormality and normal variants whether relevant or not.

In light of these findings, it is important that surgeons are trained to identify critical findings on an emergency CT scan performed in cases of trauma, where the management is time-dependent, so that the patient can be managed without delay. Short courses on basic CT scan interpretation would be invaluable to surgeons and emergency room clinicians, while with formal training of surgeons dealing with all the aspects of trauma consideration should be given to including CT interpretation in the curriculum.



 
  References Top

1.
Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: Incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev 2016;22:3-18.  Back to cited text no. 1
    
2.
World Health Organization. Injuries and Violence: The Facts 2014. Geneva: WHO; 2014. Available from: http://apps.who.int/iris/bitstream/10665/149798/1/9789241508018_eng.pdf. [Last accessed on 2019 May 08].  Back to cited text no. 2
    
3.
Diagnostic Imaging. Radiologist Sightings Drop around the World; July 14, 2003. Available from: https://www.diagnosticimaging.com/article/radiologist-sightings-drop-around-world/. [Last accessed on 2018 Jul 08].  Back to cited text no. 3
    
4.
Wong C, Taubman K, Hoehne F, Malholtra S, Naidu M, Parent D. The quality of surgical resident interpretation of after-hour CT scans of the head and abdomen in trauma. Am Surg 2005;71:772-5.  Back to cited text no. 4
    
5.
Pieroni S, Foster BR, Anderson SW, Kertesz JL, Rhea JT, Soto JA. Use of 64-row multidetector CT angiography in blunt and penetrating trauma of the upper and lower extremities. Radiographics 2009;29:863-76.  Back to cited text no. 5
    




 

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