• Accuracy of Radiographers red dot or triage of accident and emergency radiographs in clinical practice: a systematic review.

      Brealey, S.; Scally, Andy J.; Hahn, S.; Thomas, N.; Godfrey, C.; Crane, S. (2006)
      AIM: To determine the accuracy of radiographers red dot or triage of accident and emergency (A&E) radiographs in clinical practice. MATERIALS AND METHODS Eligible studies assessed radiographers red dot or triage of A&E radiographs in clinical practice compared with a reference standard and provided accuracy data to construct 2×2 tables. Data were extracted on study eligibility and characteristics, quality, and accuracy. Pooled sensitivities and specificities and chi-square tests of heterogeneity were calculated. RESULT Three red dot and five triage studies were eligible for inclusion. Radiographers' red dot of A&E radiographs in clinical practice compared with a reference standard is 0.87 [95% confidence interval (CI) 0.85¿0.89] and 0.92 (0.91¿0.93) sensitivity and specificity, respectively. Radiographers' triage of A&E radiographs of the skeleton is 0.90 (0.89¿0.92) and 0.94 (0.93¿0.94) sensitivity and specificity, respectively; and for chest and abdomen is 0.78 (0.74¿0.82) and 0.91 (0.88¿0.93). Radiographers' red dot of skeletal A&E radiographs without training is 0.71 (0.62¿0.79) and 0.96 (0.93¿0.97) sensitivity and specificity, respectively; and with training is 0.81 (0.72¿0.87) and 0.95 (0.93¿0.97). Pooled sensitivity and specificity for radiographers without training for the triage of skeletal A&E radiographs is 0.89 (0.88¿0.91) and 0.93 (0.92¿0.94); and with training is 0.91 (0.88¿0.94) and 0.95 (0.93¿0.96). CONCLUSION Radiographers red dot or triage of A&E radiographs in clinical practice is affected by body area, but not by training.
    • Interpreting trauma radiographs

      Hardy, Maryann L.; Barrett, Christine (2003-10)
      Background: Many accident and emergency clinicians regard the radiographic image as an extension of the clinical examination, as a provisional diagnosis, based on clinical signs and symptoms, can be confirmed or refuted by inspection of X-rays. However, the value of radiography in this context is not determined by the actual presence of trauma or pathology on the radiograph, but is dependent on the ability of a clinician to identify any trauma or pathology present. Traditionally, the responsibility for interpreting radiographic images within the accident and emergency environment in the United Kingdom (UK) has been with medical clinicians. However, expansion of the nursing role has begun to change the boundaries of professional practice and now many nurses are both requesting and interpreting trauma radiographs. Aim: To ascertain the ability of accident and emergency doctors and nurses to interpret trauma radiographs, and identify whether there is a consistent standard of interpretive accuracy that could be used as a measure of competence. Methods: A literature review was conducted using the Cochrane Library, Medline and CINAHL databases and the keywords radiographic interpretation, radiographic reporting, accident and emergency and emergency/nurse practitioner. Findings: The ability of accident and nursing doctors and nurses to interpret trauma radiographs accurately varies markedly, and no identified published study has established an appropriate level of accuracy that should be achieved in order to demonstrate satisfactory competence in the interpretation of radiographic images. Conclusions: Determining a measure of interpretive accuracy that can be used to assess ability to interpret radiographic trauma images is fraught with difficulties. Consequently, nurses may attempt to prove their skills by directly comparing their abilities to those of their medical colleagues. However, as a result of marked variation in the ability of senior house officers to interpret trauma radiographs, a similar ability does not automatically imply that a satisfactory level of ability has been achieved.
    • Using out-of-office blood pressure measurements in established cardiovascular risk scores: implications for practice

      Stevens, S.L.; Stevens, R.J.; de Leeuw, P.; Kroon, A.A.; Greenfield, S.; Mohammed, Mohammed A.; Gill, P.; Verberk, W.J.; McManus, R.J. (2018)
      Abstract Background: Blood pressure (BP) measurement is increasingly carried out through home or ambulatory monitoring, yet existing cardiovascular risk scores were developed for use with measurements obtained in clinic. Aim: To describe differences in cardiovascular risk estimates obtained using ambulatory or home BP measurements instead of clinic readings. Design and setting: Secondary analysis of data from adults aged 30-84 without prior history of cardiovascular disease (CVD) in two BP monitoring studies (BP-Eth and HOMERUS). Method: The primary comparison was Framingham risk calculated using BP measured as in the Framingham study or daytime ambulatory BP measurements. The QRISK2 and SCORE risk equations were also studied. Statistical and clinical significance were determined using the Wilcoxon signed-rank test and scatter plots respectively. Results: In 442 BP-Eth patients (mean age = 58 years, 50% female) the median absolute difference in 10-year Framingham cardiovascular risk calculated using BP measured as in the Framingham study or daytime ambulatory BP measurements was 1.84% (interquartile range 0.65 to 3.63, p=0.67). Only 31/ 442 (7.0%) of patients were reclassified across the 10% risk treatment threshold. In 165 HOMERUS patients (mean age = 56 years, 46% female) the median difference in 10-year risk was 2.76% (IQR 1.19 to 6.39, p<0.001) and only 8/165 (4.8%) of patient were reclassified. Conclusion: Estimates of cardiovascular risk are similar when calculated using BP measurements obtained as in the risk score derivation study or through ambulatory monitoring. Further research is required to determine if differences in estimated risk would meaningfully influence risk score accuracy.