Beyin Tomografi Yorumlamada Acil Tıp Asistan ve Uzmanları ile Radyologların Karşılaştırılması

Yıl 2021, Cilt: 47 Sayı: 3, 451 - 456, 01.12.2021

Zeynep Nazlı Sır Yeşim İşler , Halil Kaya

https://doi.org/10.32708/uutfd.993979

Öz

Çalışmanın amacı, hastanemiz acil servisine başvuran kafa travmalı çocuk hastalara çekilen kranial bilgisayarlı tomografi (BT) görüntülerinin, acil tıp asistan (ATA) ve acil tıp uzman (ATU) hekimlerinin yaptığı yorumun, radyoloji uzmanı (RU) tarafından yapılan yorum ile uyumluluğunu karşılaştırmaktır. 2 aylık dönemde Yüksek İhtisas Eğitim ve Araştırma Hastanesi acil servisine kafa travması ile başvuran ve kranial BT görüntülemesi yapılıp, bir radyoloji uzman hekimi tarafından raporlanmış kranial BT görüntüleri kullanılarak yapıldı. Çalışmaya 10 ATU ve 2 yılını doldurmuş 10 ATA gönüllü oldu. 126 hastanın kranial BT’si randomize olarak dağıtılarak ayrı ayrı değerlendirmesi istendi. RU hekiminin sonuç raporları altın standart kabul edildi. Fraktür bölgelerinde ATU ve ATA’nın RU ile uyumlu olduğu görülmektedir (κ=0,58 κ=0,68). Fraktür tipinde ATU ve ATA’nın RU ile uyumlu olduğu görülmektedir ( κ=0,58 κ=0,68). Kanama bölgesinde ATU ve ATA’ların RU ile uyumunun orta düzeyde olduğu görülmektedir (κ=0,41 κ=0,47). Kanama tipinde, ATU ve ATA’nın RU ile uyumlu olduğu görülmektedir (κ=0,54 κ=0,60). Genel olarak acil tıp asistan ve uzmanlarının kanama, fraktür ve diğer bulguları saptamada radyoloji ile uyumunun iyi düzeyde olduğu görüldü. Kanama, fraktür tipi ve lokalizasyonunda uyuma bakıldığında orta-iyi derecede olduğu görüldü. Acil tıp asistanlarının uzmanlara göre uyumunun daha yüksek olduğu görüldü.

Anahtar Kelimeler

pediatrik kafa travması, kranial BT, ATA, ATU VE RU yorumu

Destekleyen Kurum

yok

Comparison of Cranial Tomography Interpretations between Radiologists and Emergency Medicine Specialists.

Öz

The aim of the study is to compare the compatibility of the interpretation made by the emergency medicine assistant (EMA) and emergency medicine specialist (EMS) physicians of the cranial computed tomography (CT) images taken in pediatric patients with head trauma who applied to the emergency department of our hospital with the interpretation made by the radiologist (RS). Cranial CT imaging was performed using cranial CT images reported by a radiology specialist who applied to the Emergency Department of Yüksek İhtisas Training and Research Hospital with head trauma in a 2-month period. 10 EMSs and 10 EMA who have completed 2 years volunteered for the study. Cranial CT scans of 126 patients were randomly distributed and asked to be evaluated separately. The outcome reports of the RS physician were accepted as the gold standard. It is seen that EMS and EMA are compatible with RS in the fracture regions (κ=0.58 κ=0.68). It is seen that EMS and EMA are compatible with RS in the fracture type (κ=0.58 κ=0.68). In the hemorrhage region, the agreement of EMS and EMA with RS is seen to be moderate (κ=0.41 κ=0.47). In the hemorrhage region, the agreement of EMS and EMA with RS is seen to be moderate (κ=0.41 κ=0.47). In the bleeding type, EMS and EMA seem to be compatible with RS (κ=0.54 κ=0.60). In general, it was observed that the compliance of emergency medicine residents and specialists with radiology in detecting bleeding, fracture and other findings was at a good level. Bleeding, fracture type and localization were found to be moderate to good. It was observed that the compliance of emergency medicine residents was higher than the specialists.

Anahtar Kelimeler

pediatric head travma, cranial CT, EMA,EMS AND RS compliance

Kaynakça

• 1. Gedeit R. Head Injury. Pediatrics in Review 2001;22:118-24
• 2. Melo JR, Di Rocco F, Lemos-Júnior LP. et al. Defenestration in children younger than 6 years old: mortality predictors in severe head trauma. Childs Nerv Syst 2009;25:1077-83.
• 3. Abbuhl SB. Principles of emergency department use of computed tomography. In: Tintinalli JE, Kelen GD, Stopczynski JS, editors. Emergency Medicine: A Comprehensive Study Guide. 6th ed. 2004. p. 1881.
• 4. Al-Reesi A, Stiell IG, Al-Zadjali N, Cwinn AA. Comparison of CT head interpretation between emergency physicians and neuroradiologists. Eur J Emerg Med. 2010;17(5):280-2.
• 5. Cohen J. A coefficient of agreement for nominal scales, Educational and Psychological Measurement. 1960; 20:37-46
• 6. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics.1977;33:159-74
• 7. Benger JR, Lyburn ID. What is the effect of reporting all emergency department radiographs? Emerg Med J 2003;20:40–3.
• 8. Torreggiani WC, Nicolaou S, Lyburn ID, Harris AC, Buckley AR Emergency radiology in Canada: a national survey Can Assoc Radiol J. 2002 Jun;53(3):160-7
• 9. Hardman JM, Manoukian A. "Pathology of head trauma". Neuroimaging Clinics of North America 2002; 12 (2): 175–87.
• 10. Tieves KS, Yang H, Layde PM. The epidemiology of traumatic brain injury in Wisconsin, 2001. WMJ 2005;104(2):22-5
• 11. Celik S, Guven FMK. Acil Servise Minor Kafa Travması Ile Basvuran Cocukların Retrospektif Degerlendirilmesi Anatolian J Emerg Med 2020;3(1); 14-7.
• 12. Dolatabadi AA, Baratloo A, Rouhipour A, et al. Interpretation of Computed Tomography of the Head: Emergency Physicians versus Radiologists. Trauma Monthly 2013; 18(2): 86-9.
• 13. Jamal K, Mandel L, Jamal L, Gilani S. ‘Out of hours’ adult CT head interpretation by senior emergency department staff following an intensive teaching session: a prospective blinded pilot study of 405 patients. Emerg Med J 2014; 31: 467-70
• 14. Tieng N, Grinberg D, Li SF. Discrepancies in interpretation of ED body computed tomographic scans by radiology residents. Am J Emerg Med. 2007 Jan;25(1):45-8.
• 15. Khan A, Qashgari S, Al-Ali AA. Accuracy of Non-Contrast CT Brain Interpretation by Emergency Physicians: A cohort study. Pak J Med Sci. 2013 Apr;29(2):549-53.
• 16. Uğurlu, T. Travma Hastalarında Toraks Bilgisayarlı Tomografi Değerlendirmesinde Acil Tıp Asistanları İle Radyoloji Uzmanı Yorumlarının Karşılaştırılması, Uzmanlık Tezi, Dokuz Eylül Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı, 2016.
• 17. Aydın SA, Bulut M, Topal NB, Akgoz S, Koksal O, Orcan S,et al. Performance of emergency medicine residents in the interpretation of radiographs in patients with trauma. Emerg Med J. 2008 Aug;25(8):482-5.
• 18. Mucci B, Brett C, Huntly LS, Greene MK. Cranial computed tomography in trauma: the accuracy of interpretation by staff in the emergency department. Emerg Med J. 2005;22(8):538-40.
• 19. Gallagher FA , Tay KY , Vowler SL , Szutowicz H, Cross JJ , McAuley DJ. Comparing the accuracy of initial head CT reporting by radiologists, radiology trainees, neuroradiographers and emergency doctors, British Journal of Radiology. 2011 Nov; 84(1007): 1040–45
• 20. Shaker SH., Ghanbari Forushani HR., Aghdam H., Mirafzal AH., Rezai M. Agreement Analysis of Brain CT Scan findings Read by Emergency Medicine and Radiology Physicians in Patients with Head Trauma.Military med.2012;1(1):48-51
• 21. Ardic S, Guneysel O. Emergency medicine residents can assess cranial computed tomography scans consistently with radiologists. Journal of Acute Medicine 5 (2015) 92-5.
• 22. Arhami Dolatabadi A, Baratloo A, Rouhipour A, et al. Interpretation of Computed Tomography of the Head: Emergency Physicians versus Radiologists. Trauma Mon. 2013;18(2):86-9.
• 23. Khan A, Qashqari S, Al-Ali AA. Accuracy of non-contrast CT brain interpretation by emergency physicians: A cohort study. Pak J Med Sci. 2013;29(2):549-53.