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Aslaner MA, Kadı G, Kesen S, Kılıç ACK, Coşkun Ö, Bildik F, Keleş A, Demircan A, Kılıç HK, Şişik B, Korkak ÖF, Çelik GK, Arslan V, Oskay A, Can Ö, Baykan N, Yaş SC, Yazla M, Yaka E, Efgan MG, İmamoğlu M, Ak A, Koca A, Çalışkan F, Yadigaroğlu M, Eroğlu SE, İbze S, Yaman M, Taş M, Ardıç Ş, Kozacı N, Çevik Y, Sabak M, Aygün A, Koşargelir M, Aslan YE, Altuntaş G, Acar N, İlhan B. A nationwide analysis of emergency medicine residents' CT interpretation in trauma: The Tract-EM study. Am J Emerg Med 2024; 85:123-129. [PMID: 39255684 DOI: 10.1016/j.ajem.2024.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/06/2024] [Accepted: 08/24/2024] [Indexed: 09/12/2024] Open
Abstract
OBJECTIVE To evaluate the accuracy and determine the factors influencing trauma CT interpretation proficiency among emergency medicine (EM) residents in Turkey through the TraCT-EM study (Interpretation of Trauma CT by EMergency Physicians). METHODS This nationwide, multicenter, cross-sectional study was conducted in 29 academic emergency departments (EDs) from April 2023 to March 2024. A total of 401 senior EM residents participated in the study, each interpreting a standardized set of 42 trauma CT series (cranial, maxillofacial, and cervical) derived from seven patients. Interpretation accuracy was assessed, and factors predicting interpretation failure were analyzed using univariate and multivariate regression models. RESULTS The median accuracy rate of residents was 64.9 %, with higher accuracy in normal CT findings. Using the Angoff method, 14 % of residents scored below the passing threshold. Factors associated with interpretation failure included shorter interpretation times (OR, 0.97; 95 % CI, 0.95-0.99), lower self-confidence in detecting serious pathologies (OR, 2.50; 95 % CI, 1.42-4.42), reliance on in-hospital radiology department reports (OR, 3.45; 95 % CI, 1.47-8.05), and receiving final radiology reports for CT scans (OR, 3.30; 95 % CI, 1.67-6.52), and lack of in-department training programs (OR, 2.51; 95 % CI, 1.34-4.70). CONCLUSION The TraCT-EM study highlighted a 65 % accuracy rate for senior EM residents in trauma CT interpretation, with specific predictors of failure identified. These findings suggest a need for tailored radiology education strategies to enhance training and competency in trauma CT interpretation for EM residents. Further optimization of educational programs could address these gaps, ultimately improving patient outcomes in trauma care.
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Affiliation(s)
- Mehmet Ali Aslaner
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye.
| | - Gültekin Kadı
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye.
| | - Sevcihan Kesen
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | | | - Özlem Coşkun
- Department of Medical Education and Informatics, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Fikret Bildik
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Ayfer Keleş
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Ahmet Demircan
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Hüseyin Koray Kılıç
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Burak Şişik
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Ömer Faruk Korkak
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye
| | | | - Volkan Arslan
- Department of Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Alten Oskay
- Department of Emergency Medicine, Pamukkale University Faculty of Medicine, Denizli, Türkiye
| | - Özge Can
- Department of Emergency Medicine, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Necmi Baykan
- Clinic of Emergency Medicine, Kayseri City Hospital, Kayseri, Türkiye
| | - Secdegül Coşkun Yaş
- Clinic of Emergency Medicine, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Merve Yazla
- Clinic of Emergency Medicine, Ankara Etlik City Hospital, Ankara, Türkiye
| | - Elif Yaka
- Department of Emergency Medicine, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
| | - Mehmet Göktuğ Efgan
- Department of Emergency Medicine, İzmir Katip Çelebi University Faculty of Medicine, İzmir, Türkiye
| | - Melih İmamoğlu
- Department of Emergency Medicine, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Ahmet Ak
- Department of Emergency Medicine, Selçuk University Faculty of Medicine, Konya, Türkiye
| | - Ayça Koca
- Department of Emergency Medicine, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Fatih Çalışkan
- Department of Emergency Medicine, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
| | - Metin Yadigaroğlu
- Department of Emergency Medicine, Samsun University Faculty of Medicine, Samsun, Türkiye
| | - Serkan Emre Eroğlu
- Department of Emergency Medicine, University of Health Sciences, Umraniye Health Practice and Research Center, İstanbul, Türkiye
| | - Süleyman İbze
- Department of Emergency Medicine, Akdeniz University Faculty of Medicine, Antalya, Türkiye
| | - Mahmut Yaman
- Department of Emergency Medicine, Dicle University Faculty of Medicine, Diyarbakır, Türkiye
| | - Mahmut Taş
- Clinic of Emergency Medicine, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Türkiye
| | - Şenol Ardıç
- Department of Emergency Medicine, Trabzon Kanuni Training and Research Hospital, Trabzon, Türkiye
| | - Nalan Kozacı
- Department of Emergency Medicine, Alanya Alaaddin Keykubat University Faculty of Medicine, Antalya, Türkiye
| | - Yunsur Çevik
- Clinic of Emergency Medicine, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Türkiye
| | - Mustafa Sabak
- Department of Emergency Medicine, Gaziantep University Faculty of Medicine, Gaziantep, Türkiye
| | - Ali Aygün
- Department of Emergency Medicine, Ordu University Faculty of Medicine, Ordu, Türkiye
| | - Mehmet Koşargelir
- Clinic of Emergency Medicine, Haydarpaşa Numune Training and Research Hospital, İstanbul, Türkiye
| | - Yusuf Ertuğrul Aslan
- Department of Emergency Medicine, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Gürkan Altuntaş
- Department of Emergency Medicine, Recep Tayyip Erdoğan University Faculty of Medicine, Rize, Türkiye
| | - Nurdan Acar
- Department of Emergency Medicine, Eskişehir Osmangazi University School of Medicine, Eskişehir, Türkiye
| | - Buğra İlhan
- Department of Emergency Medicine, Kırıkkale University Faculty of Medicine, Kırıkkale, Türkiye
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Duxbury O, Burling D, Muckian J, Lung P, Obaro A, Smith K, Plumb A. Meeting the new joint British Society of Gastrointestinal and Abdominal Radiology and Royal College of Radiologists CT colonography standards: a 6-year experience. Clin Radiol 2021; 76:665-673. [PMID: 34148642 DOI: 10.1016/j.crad.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
AIM To audit the performance of computed tomography colonography (CTC) at St Mark's Hospital against the joint British Society of Gastrointestinal and Abdominal Radiology (BSGAR) and Royal College of Radiologists (RCR) standards. MATERIALS AND METHODS A retrospective audit of all CTC studies between January 2012 to December 2017 was performed against the BSGAR/RCR standards along with additional data outwith the guidelines. Evidence was obtained from a central database, radiology information systems (RISs), picture archiving and communication systems (PACSs), and electronic patient records (EPRs). RESULTS Over the 6 years, 13,143 CTCs were performed and 12,996 (99%) were adequate or better. Of the cases 1,867 had a >6 mm polyp or cancer reported (polyp identification rate [PIR] 14%) and the positive predictive value (PPV) was 93% (1,148/1,240). Median radiation dose was 458 mGy·cm, mean additional acquisition rate was 19% (2,505/13,143), subsequent endoscopy rate was 9% (1,222/13,143) and mean interpretation time for a negative study was 34.6 minutes. Nine perforations occurred (perforation rate of 0.068%) and one was symptomatic (symptomatic perforation rate of 0.008%). For suspected cancers, the same-day endoscopy rate was 27% (96/360) and same-day staging rate was 76% (272/360). Post-imaging colorectal cancer rates (PICRC) was 3.06 per 100 cancers detected and 0.23 per 1,000 CTCs. The service was always rated "good" or higher by patients. CONCLUSION This audit shows the CTC service at St Mark's Hospital to be safe and of sufficiently high quality to meet the BSGAR/RCR standards with most outcomes equal to or above the aspirational target. Areas for service and individual reader improvement were also identified.
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Affiliation(s)
- O Duxbury
- Intestinal Imaging Centre, St Mark's Hospital, Harrow, UK
| | - D Burling
- Intestinal Imaging Centre, St Mark's Hospital, Harrow, UK.
| | - J Muckian
- Intestinal Imaging Centre, St Mark's Hospital, Harrow, UK
| | - P Lung
- Intestinal Imaging Centre, St Mark's Hospital, Harrow, UK
| | - A Obaro
- Intestinal Imaging Centre, St Mark's Hospital, Harrow, UK; Centre for Medical Imaging, University College London, London, UK
| | - K Smith
- Intestinal Imaging Centre, St Mark's Hospital, Harrow, UK
| | - A Plumb
- Centre for Medical Imaging, University College London, London, UK
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Peprah D, Plumb A, Corr A, Muckian J, Smith K, Sergot A, Kuah JY, Stephenson J. Re-initiation of CT colonography services during the COVID-19 pandemic: Preliminary evaluation of safety. Br J Radiol 2021; 94:20201316. [PMID: 33835838 PMCID: PMC8506191 DOI: 10.1259/bjr.20201316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: The COVID-19 pandemic has led to cancellation and deferral of many cancer investigations, including CT colonography (CTC). In May 2020, BSGAR and SCoR issued guidelines outlining steps for conduct of CTC in the early recovery phase. We evaluated the implementation of these in four English hospital trusts. Methods: Ethical permission was not required for this multicentre service evaluation. We identified patients undergoing CTC over a 2-month period from May to July 2020 at four Trusts. We recorded demographics, scan indications, colonic findings, and incidental lung base changes compatible with COVID-19. A subset of patients were contacted via telephone to document new symptoms 2 weeks following their scan. Staff were contacted to determine if any acquired COVID-19 during the period. Results: 224 patients (118 male, 52.7%) were scanned during the period. In 55 patients (24.6%), CTC showed a ≥6 mm polyp. 33 of 224 (14.7%) scans showed incidental lung base changes felt unrelated to COVID-19, and only one patient had changes indeterminate for COVID-19; no classic COVID-19 pulmonary changes were found. Of 169 patients with telephone follow-up, none reported any new symptoms of COVID-19 (cough, fever, anosmia, ageusia) within 14 days of CTC. None of the 86 staff contacted developed COVID-19. Conclusion: We found no cases of patients or staff acquiring COVID-19 infection following CTC; and no evidence of significant asymptomatic COVID-19 patients attending for CTC appointments based on lung base changes. Advances in knowledge: Our findings suggest that current practice is unlikely to contribute significantly to spread of SARS-nCOV2. Cancer and significant polyp detection rates were high, underlining the importance of maintaining service provision.
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Affiliation(s)
- David Peprah
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Andrew Plumb
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Alison Corr
- St Mark's Hospital NHS Trust, Harrow, United Kingdom
| | | | - Kathryn Smith
- St Mark's Hospital NHS Trust, Harrow, United Kingdom
| | - Antoni Sergot
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jia Ying Kuah
- Gastrointestinal Imaging Group, University Hospitals Leicester NHS Trust, Leicester, United Kingdom
| | - James Stephenson
- Gastrointestinal Imaging Group, University Hospitals Leicester NHS Trust, Leicester, United Kingdom
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