Interpretation of emergency CT angiograms in vascular trauma – vascular surgeon vs radiologist

Abstract

Background: This study aims to investigate any discrepancy in interpretation of computed tomography (CT) angiograms (CTA) in  suspected traumatic arterial injury by vascular specialists and radiology specialists, and the influence of any discrepancies on patient  outcome.

Methods: A prospective observational comparative study of 6-month duration was undertaken at a tertiary hospital in Durban, South  Africa. Haemodynamically stable patients with suspected isolated vascular trauma admitted to a tertiary vascular surgery service who  underwent a CTA on admission were reviewed. The interpretations of CTAs were compared between vascular surgeons, vascular trainees  and radiology trainees with the consultant radiologist report as the gold standard comparator.

Results Of 131 CTA consultant radiologist  reports, the radiology registrar concurred with 89%, which was less than the vascular surgeon who correctly interpreted 120 out of 123  negative cases with three false positives. There were no false negatives or descriptive errors. A 100% sensitivity (95% CI 63.06–100) and  97.62% (95% CI 93.20–99.51) specificity was noted for the vascular surgeon. Overall agreement was 97.71 % with Cohen’s kappa value =  0.83 (95% CI 0.64–1.00) indicating very good agreement. Apart from three negative direct angiograms, patient management and outcome  were not impacted by the vascular surgeons’ errors in interpretation.

Conclusion: There is very good inter-observer agreement  in the interpretation of CTAs in trauma between the vascular surgeon and radiologist with no negative impact on patient  outcome.