Comparison of CT head interpretation between emergency physicians and neuroradiologists

Cranial computed tomography (CT) of the head is widely used in the emergency department 24 h a day. We compared the accuracy of CT head interpretation between staff emergency physicians (EPs) and neuroradiologists. We conducted a health records review of patients who required head CT in the emergency department. Two independent reviewers rated disagreement as clinically normal, significant, or clinically insignificant findings using published definition criteria. We calculated concordance and prepared descriptive and kappa statistics with 95% confidence intervals using SAS 9.1 software. We included 442 for this study. CT heads were classified as: normal or nonacute 81.5% (360 cases), insignificant 3.8% (17 cases), and significant 14.7% (65 cases). The weighted kappa for agreement was 0.83 (95% confidence interval 0.76-0.90). None of these patients had adverse outcomes related to EP misinterpretation of the CT head. In conclusion, clinically important findings on CT head are not commonly missed by our EPs and patients rarely have inappropriate disposition.