Radiographer Preliminary Image Evaluation Accuracy in Interpreting Paediatric Trauma Radiographs

Radiographer preliminary image evaluation (PIE) is a patient safety mechanism where radiographers provide a written comment describing potential pathology in radiographs they have acquired. This can assist emergency referrers in making a diagnosis when a radiologist's report is unavailable. The aim of this study was to evaluate the accuracy of radiographer PIE in interpreting paediatric trauma radiographs in an Australian emergency department.

A randomised sample of paediatric radiographic examinations (aged 16 years and under) from January 2022 to June 2023 was retrospectively reviewed. The anatomical regions reviewed included the appendicular and axial skeleton, chest and abdomen. The PIE for each examination was compared to the radiologist report to indicate if the radiographer's evaluation was a true negative/positive or false negative/positive value. This was used to calculate mean sensitivity, specificity and diagnostic accuracy. Discrepant PIE interpretations were further investigated.

A total of 498 PIEs were reviewed. The overall accuracy, sensitivity and specificity were 93.3%, 84.3% and 98.1%, respectively. Cases with no participation and those marked as unsure for pathology represented 0.4% and 2.6% of the sample, respectively. The extremities were identified as a region frequently misinterpreted.

Radiographers in this study maintained a high diagnostic accuracy in interpreting paediatric radiographs. PIE may complement the emergency referrer's diagnosis when a radiologist report is unavailable to promote appropriate and timely treatment for paediatric patients in the emergency department. Further research with a larger sample may support targeted training to improve PIE performance in regions frequently misinterpreted.