Cranial computed tomography in trauma: the accuracy of interpretation by staff in the emergency department

Objectives: Cranial computed tomography (CT) is replacing skull radiography in head trauma. Rapid radiological opinions on these images may not always be available. We assessed the ability of our permanent emergency department staff to interpret the images. Methods: A retrospective series of 100 consecutive cases was reviewed and interpreted by five permanent emergency department medical staff, and their interpretation compared with the consensus opinion of two radiologists. Results: An overall agreement of 86.6% (95% confidence interval (CI) 83.4 to 89.9) was achieved, with a false negative rate of 4.2% (95% CI 3.9 to 4.3). No findings that would have changed the overnight management of any patient were missed. Conclusions: Our results for CT scans are similar to studies of interpretation of other radiographic images in emergency departments. Our emergency staff could safely make the initial interpretation of cranial CT images in trauma out of hours, and formal reporting may wait until a suitably experienced radiologist is available.