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      Accuracy of after-hour 'red dot' trauma radiograph triage by radiographers in a South African regional hospital

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          Abstract

          BACKGROUND: The global demand for diagnostic imaging exceeds the supply of radiologists and is of particular significance in poorly resourced healthcare environments where many radiographs are unreported. Delayed or absent reporting may negatively impact patient management. In well-resourced countries there is recognition that extending the role of radiographers to radiological reporting tasks helps meet service demands. AIM: To determine the accuracy of acute fracture detection by South African radiographers working in an after-hour setting. METHOD: We performed a retrospective study of radiographers at a Western Cape Regional Hospital over 2 months in 2011. The sensitivity and specificity of radiographers' fracture detection were compared with that of a consultant radiologist. Differences were evaluated using the McNemar chi-squared test, with p<0.05 regarded as significant. RESULTS: A total of 369 radiographs were analysed. The overall accuracy of reporting by radiographers was 93.7%, with 74.4% sensitivity for fracture detection. Experienced radiographers performed better than inexperienced radiographers; adult fractures were more consistently identified than paediatric fractures, and appendicular fractures were better visualised than axial fractures. In all instances there was a significant difference between fracture detection by radiographers and the radiologist. Experienced radiographers evaluating appendicular fractures in adults achieved the highest sensitivity (89.9%), which was not significantly different from that of a consultant radiologist (p=0.88). CONCLUSION: The performance of experienced radiographers in our study is comparable with that of experienced radiographers internationally, who have no specific training in trauma radiograph reporting. However, additional training is required if role extension is to be considered.

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          Most cited references 10

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          Radiographers' role in radiological reporting: a model to support future demand.

          The demand for diagnostic imaging services has grown faster than the supply of radiologists in Australia. Given the predicted ageing of the population and contraction of the health care workforce, the current workforce model is not sustainable. Extending the role of radiographers in a specific range of radiological reporting tasks may help meet demand, relieving some pressure on radiologists. Experience overseas suggests that radiographer reporting can reduce patient waiting times, release radiologists for other duties and improve the retention of radiographers. Evidence shows that, with appropriate education and training, the accuracy of radiographers in interpreting plain x-rays is comparable to that of radiologists. Australian universities are well placed to offer radiographers postgraduate education in image interpretation.
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            Reporting of fracture radiographs by radiographers: the impact of a training programme.

             C Loughran (1994)
            In order to determine what influence training would have on their ability to interpret skeletal radiographs from the accident and emergency department, a 6 months training programme was established for three radiographers in various aspects of the radiology of orthopaedics and skeletal trauma. During the study the radiographers reported on radiographs from the accident and emergency department and each month an evaluation of their accuracy was undertaken. The overall radiographer error rate for fracture detection (false positive and false negative) declined during the training period. This was highly significant (p < 0.001). The sensitivity for fracture detection improved from 81.1% at the commencement of the trial to 95.9% at the end. This was also highly significant (p < 0.001). Radiographer specificity for the exclusion of fractures also improved from 94.4% during the first 2 months to 96.6% in the final 2 months, and this was also significant (p < 0.05). The overall error rate of two of the three radiographers improved significantly (p < 0.001) but for one radiographer the improvement did not reach a level of statistical significance. The difference in sensitivity for fracture detection at the commencement of the trial period between radiologist and radiographer was highly significant (p < 0.001), but there was no statistically significant difference during the last two months of the trial. The difference in specificity between radiologist and radiographer remained highly significant both at the beginning and the end of the trial (p < 0.001). Experienced radiographers who receive supplementary training in the radiology of skeletal trauma can significantly improve their diagnostic skills and can report such radiographs with a high degree of accuracy. A programme of training and certification of radiographers in fracture reporting could help alleviate the diagnostic radiologists' workload of plain film reporting.
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              How well can radiographers triage x ray films in accident and emergency departments?

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                Author and article information

                Affiliations
                [1 ] Universiteit Stellenbosch South Africa
                [2 ] Universiteit Stellenbosch South Africa
                Contributors
                Role: ND
                Role: ND
                Journal
                samj
                SAMJ: South African Medical Journal
                SAMJ, S. Afr. med. j.
                Health and Medical Publishing Group (Cape Town )
                2078-5135
                2013
                : 103
                : 9
                : 638-640
                S0256-95742013000900022

                http://creativecommons.org/licenses/by/4.0/

                Product
                Product Information: SciELO South Africa
                Categories
                Health Care Sciences & Services
                Health Policy & Services
                Medical Ethics
                Medicine, General & Internal
                Medicine, Legal
                Medicine, Research & Experimental

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