Can middle grade and consultant emergency physicians accurately interpret computed tomography scans performed for head trauma? Cross-sectional study.

BACKGROUND: There has been an increasing demand for computed tomography (CT) scans of the head following trauma over the past 10 years. This has placed radiology services under pressure. AIMS: This study aimed to see whether middle grade and consultant doctors with no particular training in radiology working in the emergency department could interpret CT scans performed for trauma with adequate sensitivity and specificity to allow safe discharge. The secondary aim was to describe which abnormalities, if any, were missed. METHODS: Study participants were middle grade and consultant emergency physicians. A comparison was made of the ability to identify any abnormality on CT and a clinically important brain injury on CT, compared with a gold standard of a neuroradiology report. RESULTS: 243 consecutive CT scans performed for trauma were reviewed by 17 doctors, including five consultants. The overall sensitivity and specificity for detecting clinically important brain injuries was 87.8 (95% CI 73.8 to 95.9) and 80.2 (95% CI 75.2 to 85.3), respectively. All the missed abnormalities were around the base of the brain. The most commonly overdiagnosed abnormality was diffuse cerebral oedema. CONCLUSIONS: Emergency physicians should not interpret CT scans for trauma without extra training.

The significance of post-traumatic amnesia as a risk factor in the development of olfactory dysfunction following head injury.

OBJECTIVE: To test the following hypothesis in the assessment of head injury PATIENTS: only patients with 5 min or more of post-traumatic amnesia (PTA) are at risk of acute olfactory dysfunction (OD). METHODS: This was a retrospective comparative study of olfactory status in head injury patients seen at a head injury clinic at Glasgow Royal Infirmary from 1985 to 2003. Of 828 clinic attenders, 101 had acute OD. These subjects were compared with a randomly selected control group of 102 patients with head injury but normal olfactory function. The main outcome measure was a significant likelihood of patients with PTA lasting for 5 or more minutes having acute OD compared with those with PTA of less than 5 min. RESULTS: The likelihood of patients with a PTA of 5 min or more having acute OD compared to those with PTA of less than 5 min is clinically significant with an odds ratio of 9.6 (p<0.01). CONCLUSION: Examination of patients with 5 min or more of PTA should include a simple test of sense of smell. Patients with impaired smell sensation should be aware of their condition prior to discharge from hospital. In addition, the need for a CT brain scan and appropriate follow up should be considered.