Keywords

Trauma; Emergency; Radiology; Unreported; Radiographs

Introduction

Reporting trauma radiographs provide important information to the medical decision-making process occurring in the Emergency Department (ED). So it should be done accurately and immediately [1]. The proper interpretation of radiographs will help a better management to the patient condition in ER [2]. In the context of this study, unreported refer to the radiographs didn’t interpret while reported refers to the interpreted ones by an authorized physician. However, due to the global shortage of radiologists, emergency medicine physicians (EMP) are largely responsible for acute trauma plain radiograph interpretation in public- sector health-care facilities in well-resourced countries [3,4]. The shortage of radiologists results in most acute trauma radiographs being unreported [3,5]. Training, experience and commitment are required to achieve optimum accuracy in interpretation of ER radiograph [6,7].

The information from the radiographic image determines the plan and method of treatment [8]. Overwhelmingly, images are initially interpreted by EMP and the diagnosis depends on this initial interpretation. In several institutions, radiographs are transferring to radiologist for confirmation the diagnosis. The purpose of this study included two specific objectives. The first objective was to count how many reported and unreported routine trauma radiographs for adults in ER at KAUH setting over a 12 months period. The second objective was to know how long it takes to get reported. To the best of our knowledge, this is the first study of its kind on the Arab countries.

Materials and Methods

The study was undertaken from January 2015 through December 2016 in the ER at KUH which include a 1002 -bed public-sector hospital in the Western Area of Saudi Arabia [9]. Gathered data from the picture archiving and communication system (PACS) and Sectra program were transcribed into an Excel spreadsheet. The percentage and frequency of reported/ unreported radiographs from each anatomical part from the audit of sequential cases over the 12-month period was documented. 3,816 cases of adults on trauma preliminary radiograph images (routine x-ray) were obtained through study period. The data was collection based on the number of reported and unreported conventional trauma radiographs of adults, if the case has been reported then, to know how long time it takes until get reported (immediately, 1-6 hours or more). Statistical SPSS 16.0 software analyzed data and Kendall's tau-b (Correlation is significant at the P-value 0.01)

Results

100% (n=3,816/3,816) of routine adults radiographs in ER at KAUH unreported and 0.00% (n=0.00/3,816) reported during study period. In summary, the audit included 3,816 unreported radiograph distributed across anatomical parts of limbs (19.29%), spine (2.73%), abdomen/pelvis (11.14%), chest (66.30%) and skull (0.55%) (Table 1). Also noteworthy is the significantly difference of unreported comparison with reported ones (p=0.000).

Table 1: Reported and unreported radiographs.

Discussion

To the authors' knowledge, this is the first study conducted in the area to detect the number of reported and unreported cases in ER at KAUH. The results are disappointing, because the procedures of interpretation radiographs in ER didn't meets the Royal College of Emergency Medicine (RCEM), United Kingdom(UK) best practice guideline to management of radiology results in the ED, February 2016. They recommend all radiological imaging performed in the ED have a formal report by a radiologist [10,11]. The General- Medical- Council, UK in its guidance over roles and accountability should ensure clarity [12].

The current status in ER at KAUH similar to institutions of emergency care settings, radiographic images interpret by Health Practitioners (HP) as part of their duty [13]. HP may include radiographers, physiotherapists, nurses and medical professionals prior to the report of radiologist [14-17]. But we haven't any explanation how and why there is no one radiograph interpreted by radiologist? Similar studies have reported radiographs usually interpreted by physicians (not radiologists) but who have enough experience in their radiography interpretations to support clinical decision making, which is not a study objective, so it didn't take into account. Important study of interpretation of ED radiographs was conducted by John et al. declared a significant difference of equal or greater magnitude associated with the training level and physician specialty. Another study by McLauchlan et al. showed that the majority of junior doctors in accident and emergency departments misdiagnosed significant trauma abnormalities on x-ray [16,17].

One of the objectives of this study is to determine the duration of time was taken to get reported. But we are unable to achieve that because all collected radiographs during this study unreported. Regarding to interpret a radiographic examination the Royal College of Radiologists (RCR), UK recommends an average time approximately 90 s/examination [18-19].

Conclusion

Although it does not satisfy the ambition and guidance of the administration of radiology department to improve and develop service, the current status of interpreting routine radiographs for adults in ER at KAUH have been displayed. In conclusion, we hoped this study will stimulate for crucial procedures to apply the guidance of RCEM and RCR to promote the provision of high quality service to traumatic patients.

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