Assessment of pediatric emergency physicians' interpretation of brain non-contrast computed tomography: a prospective study in a tertiary care center

Abstract

This study aims to prospectively assess the proficiency of pediatric emergency physicians (PEPs) in interpreting non-contrast computed tomography (NCCT) brain images. A prospective investigation was conducted at the pediatric emergency unit of King Saud University Medical City (KSUMC), Saudi Arabia, over a one-year period. All patients undergoing plain brain NCCT during this period were enrolled. An independent attending neuroradiologist and two certified pediatric emergency consultants compared the interpretations of PEPs with the official final reports issued by the on-call radiologist. A total of 202 pediatric patients were examined, all under 14 years of age, with a mean age of 4.8 ± 3.6 years. Trauma was the predominant presenting complaint (127 patients, 62.9%), followed by seizures (28 patients, 13.9%). The primary indication for brain NCCT was to detect intracranial bleeding, identified in 134 patients (66.3%), followed by a space-occupying lesion in 22 patients (10.9%). Additionally, hydrocephalus with elevated intracranial pressure (ICP) was observed in 20 patients (9.9%). The overall agreement between PEPs and radiologists, based on Landis and Koch benchmark classification, was moderate (Kappa = 0.578), with an accuracy of 82.18%. The overall accuracy of brain NCCT interpretation by PEPs compared to radiologists was found to be moderate. Further multicenter studies in pediatric emergency settings with larger sample sizes are warranted to validate these findings.