Assessment of pediatric emergency physicians' interpretation of brain non-contrast computed tomography: a prospective study in a tertiary care center

This study aims to prospectively assess the proficiency of pediatric emergency physicians (PEPs) in interpreting non-contrast computed tomography (NCCT) brain images. A prospective investigation was conducted at the pediatric emergency unit of King Saud University Medical City (KSUMC), Saudi Arabia, over a one-year period. All patients undergoing plain brain NCCT during this period were enrolled. An independent attending neuroradiologist and two certified pediatric emergency consultants compared the interpretations of PEPs with the official final reports issued by the on-call radiologist. A total of 202 pediatric patients were examined, all under 14 years of age, with a mean age of 4.8 ± 3.6 years. Trauma was the predominant presenting complaint (127 patients, 62.9%), followed by seizures (28 patients, 13.9%). The primary indication for brain NCCT was to detect intracranial bleeding, identified in 134 patients (66.3%), followed by a space-occupying lesion in 22 patients (10.9%). Additionally, hydrocephalus with elevated intracranial pressure (ICP) was observed in 20 patients (9.9%). The overall agreement between PEPs and radiologists, based on Landis and Koch benchmark classification, was moderate (Kappa = 0.578), with an accuracy of 82.18%. The overall accuracy of brain NCCT interpretation by PEPs compared to radiologists was found to be moderate. Further multicenter studies in pediatric emergency settings with larger sample sizes are warranted to validate these findings.

Emergency medicine; Computed tomography; Pediatric emergency physician; Radiologist

[1] Gajurel I, Shakya YL, Neupane RP, Shrestha B, Gupta S, Karki S. Head computed tomography findings in relation to red flag signs among patients presenting with non-traumatic headache in the emergency services. Journal of Patan Academy of Health Sciences. 2021; 8: 79–86.

[2] Sert ET, Mutlu H, Kokulu K. The use of PECARN and CATCH rules in children with minor head trauma presenting to emergency department 24 hours after injury. Pediatric Emergency Care. 2022; 38: e524–e528.

[3] Vonk S, Leermakers J, Logtenberg SJ, Sankatsing SU. Factors associated with emergency department length of stay of internal medicine patients. Emergency Care Journal. 2021; 17: 9570.

[4] Khan A, Qashqari S, Al-Ali AA. Accuracy of non-contrast CT brain interpretation by emergency physicians: a cohort study. Pakistan Journal of Medical Sciences. 2013; 29: 549–553.

[5] Al Aseri Z, Al Aqeel M, Aldawood B, Albadr F, Ghandour R, Al Mulaik A, et al. Accuracy of brain computed tomography diagnosis by emergency medicine physicians. Computational Intelligence and Neuroscience. 2022; 2022: 5659129.

[6] Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33: 159–174.

[7] Knuckey NW, Stokes BAR. Subarachnoid haemorrhage: epidemiology, natural history, and surgical treatment. Medical Journal of Australia. 1981; 2: 651–654.

[8] Spazzapan P, Krašovec K, Velnar T. Risk factors for bad outcome in pediatric epidural hematomas: a systematic review. Chinese Neurosurgical Journal. 2019; 5: 19.

[9] Jayawant S, Parr J. Outcome following subdural haemorrhages in infancy. Archives of Disease in Childhood. 2007; 92: 343–347.