Accuracy Of Emergency Physicians Research Articles

Consensus paper on the management of acute isolated vertigo in the emergency department.

Acute vertigo is defined as the perception of movement of oneself or the surroundings in the absence of actual motion and it is a frequent cause for emergency department admissions. The utilization of medical resources and the duration of hospital stay for this kind of symptom is high. Furthermore, the efficiency of brain imaging in the acute phase is low, considering the limited sensitivity of both CT and MRI for diagnosing diseases that are the causes of central type of vertigo. Relying on imaging tests can provide false reassurance in the event of negative results or prolong the in-hospital work-up improperly. On the other hand, clinical examinations, notably the assessment of nystagmus' features, have proven to be highly accurate and efficient when performed by experts. Literature data point out that emergency physicians often do not employ these skills or use them incorrectly. Several clinical algorithms have been introduced in recent years with the aim of enhancing the diagnostic accuracy of emergency physicians when evaluating this specific pathology. Both the 'HINTS and 'STANDING' algorithms have undergone external validation in emergency physician hands, showing good diagnostic accuracy. The objective of this consensus document is to provide scientific evidence supporting the clinical decisions made by physicians assessing adult patients with acute vertigo in the emergency department, particularly in cases without clear associated neurological signs. The document aims to offer a straightforward and multidisciplinary approach. At the same time, it tries to delineate benchmarks for the formulation of local diagnostic and therapeutic pathways, as well as provide a base for the development of training and research initiatives.

Teaching distinguishing semiological features improves diagnostic accuracy of seizure-like events by emergency physicians

BackgroundMisdiagnosis of seizure-like events (SLE) in emergency situations is common. Here, we evaluate whether a single, video-based lesson highlighting distinguishing semiological features can improve the diagnostic accuracy of emergency physicians for epileptic seizures (ES), psychogenic non-epileptic seizures (PNES) and syncopes (SY).Methods40 emergency physicians (24 anesthetists, nine surgeons and seven internal medicine specialists by primary specialty) participated in a prospective trial on the diagnostic accuracy of SLE. They assessed video-displayed SLE at two time points: before and after a lecture on distinguishing semiological features. In the lecture, semiological features were demonstrated using patient videos, some were acted by the instructor in addition. The increase in correct diagnoses and recognition of distinguishing semiological features were analyzed.ResultsBefore the lesson, 45% of 200 SLE-ratings were correct: 15% of SY (n = 40), 30% of PNES (n = 40), 59% of ES (n = 120, focal to bilateral tonic–clonic seizures (FBTCS) 87.5% (n = 40), focal impaired aware seizures (FIAS) 45% (n = 80)). Semiology teaching increased both the rate of correct diagnoses of SLE to overall 79% (p < 0.001) (ES 91% (p < 0.001), FBCTS 98% (n.s.), FIAS 88% (p < 0.001), PNES 88% (p < 0.001), SY 35% (p < 0.001)), and the number of recognized distinguishing semiological features. We identified several semiological features with high entity specific positive predictive values (> 0.8).ConclusionsA single 45-min video-based lesson highlighting distinguishing semiological features improves the diagnostic accuracy of ES, PNES and SY by emergency physicians. We expect that including this aspect into the curriculum of emergency physicians will lead to better individual patient treatment in pre-hospital medicine and more appropriate subsequent use of clinical resources.

Accuracy of emergency physicians' interpretation of computed tomography for urgent-emergent diagnoses in nontraumatic cases.

OBJECTIVE:The aim of this study is to evaluate the accuracy levels of the emergency physicians (EPs) managing the patient in the interpretation of the urgent-emergent pathological findings in thoracic and abdominal computed tomography (CT) scans.METHODS:The EPs interpreted the CT scans of patients who visited the emergency department because of nontraumatic causes. Then, a radiology instructor made final assessments of these CT scans. Based on the interpretation of the radiology instructor, the false-positive rate, false-negative rate, sensitivity, specificity, positive predictive value, negative predictive value, and kappa coefficient (κ) of the EPs’ interpretations of the CT scans were calculated.RESULTS:A total of 268 thoracics and 185 abdominal CT scans were assessed in our study. The overall sensitivity and specificity of the EPs’ interpretation of the thoracic CT scans were 90% and 89%, respectively, whereas the abdominal CT interpretation was 88% and 86%, respectively. There was excellent concordance between the EPs and the radiology instructor with regard to the diagnoses of pneumothorax, pulmonary embolism, pleural effusion, parenchymal pathology, and masses (κ: 0.90, κ: 0.87, κ: 0.71, κ: 0.79, and κ: 0.91, respectively) and to the diagnoses of intraabdominal free fluid, intraabdominal free gas, aortic pathology, splenic pathology, gallbladder pathology, mesenteric artery embolism, appendicitis, gynecological pathology, and renal pathology (κ: 1, κ: 0.92, κ: 0.96, κ: 0.88, κ: 0.80, κ: 0.79, κ: 0.89, κ: 0.88, and κ: 0.82, respectively).CONCLUSION:The EPs are successful in the interpretation of the urgent-emergent pathological findings in thoracic and abdominal CT scans.

Accuracy of emergency physicians\u2019 self-estimates of CT scan utilization and its potential effect on an audit and feedback intervention: a randomized trial

BackgroundAudit and feedback (A&F) has been used as a strategy to modify clinician behavior with moderate success. Although A&F is theorized to work by improving the accuracy of clinicians’ estimates of their own behavior, few interventions have included assessment of clinicians’ estimates at baseline to examine whether they account for intervention success or failure. We tested an A&F intervention to reduce computed tomography (CT) ordering by emergency physicians, while also examining the physicians’ baseline estimates of their own behavior compared to peers.MethodsOur study was a prospective, multi-site, 20-month, randomized trial to examine the effect of an A&F intervention on CT ordering rates, overall and by test subtype. From the electronic health record, we obtained 12 months of baseline CT ordering per 100 patients treated for every physician from four emergency departments. Those who were randomized to receive A&F were shown a de-identified graph of the group’s baseline CT utilization, asked to estimate wherein the distribution of their own CT order practices fell, and then shown their actual performance. All participants also received a brief educational intervention. CT ordering rates were collected for all physicians for 6 months after the intervention. Pre-post ordering rates were compared using independent and repeated measures t tests.ResultsFifty-one of 52 eligible physicians participated. The mean CT ordering rate increased significantly in both experimental conditions after the intervention (intervention pre = 35.7, post = 40.3, t = 4.13, p < 0.001; control pre = 33.9, post = 38.9, t = 3.94, p = 0.001), with no significant between-group difference observed at follow-up (t = 0.43, p = 0.67). Within the intervention group, physicians had poor accuracy in estimating their own ordering behavior at baseline: most overestimated and all guessed that they were in the upper half of the distribution of their peers. CT ordering increased regardless of self-estimate accuracy.ConclusionsOur A&F intervention failed to reduce physician CT ordering: our feedback to the physicians showed most of them that they had overestimated their CT ordering behavior, and they were therefore unlikely to reduce it as a result. After “audit,” it may be prudent to assess baseline clinician awareness of behavior before moving toward a feedback intervention.

The Accuracy of Emergency Physicians' Suspicions of Active Pulmonary Tuberculosis.

Objective: To investigate factors associated with recognition and delayed isolation of pulmonary tuberculosis (PTB). Background: Precise identification of PTB in the emergency department (ED) remains challenging. Methods: Retrospectively reviewed PTB suspects admitted via the ED were divided into three groups based on the acid-fast bacilli culture report and whether they were isolated initially in the ED or general ward. Factors related to recognition and delayed isolation were statistically compared. Results: Only 24.94% (100/401) of PTB suspects were truly active PTB and 33.77% (51/151) of active PTB were unrecognized in the ED. Weight loss (p = 0.022), absence of dyspnea (p = 0.021), and left upper lobe field (p = 0.024) lesions on chest radiographs were related to truly active PTB. Malignancy (p = 0.015), chronic kidney disease (p = 0.047), absence of a history of PTB (p = 0.013), and lack of right upper lung (p ≤ 0.001) and left upper lung (p = 0.020) lesions were associated with PTB being missed in the ED. Conclusions: Weight loss, absence of dyspnea, and left upper lobe field lesions on chest radiographs were related to truly active PTB. Malignancy, chronic kidney disease, absence of a history of PTB, and absence of right and/or left upper lung lesions on chest radiography were associated with isolation delay.

Accuracy of Emergency Physicians for Detection of Regional Wall Motion Abnormalities in Patients With Chest Pain Without ST‐Elevation Myocardial Infarction

Our aim was to evaluate the accuracy of emergency physicians (EPs) in the detection of regional wall motion abnormalities (RWMAs) using focused cardiac ultrasound (FOCUS) in patients suspected of non-having ST-elevation myocardial infarction. We prospectively enrolled patients with chest pain. Three EPs underwent didactics and hands-on-training, of 3 hours each, by an experienced cardiologist, on detecting RWMAs using 2-dimensional echocardiography. They performed a FOCUS examination to evaluate for RWMAs and recorded the echo images. Our reference standard for the detection of RWMAs was accepted as a blinded cardiologist review of the prerecorded video clips. We calculated the corrected sample size and inter-rater agreement between the EPs (82 and 0.83, respectively). The analysis of the study was performed on 89 patients. Eighty-nine patients with chest pain were screened. Emergency physicians demonstrated the detection of RWMAs with good sensitivity and even excellent specificity: 76.9% (95% confidence interval [CI], 56.4%- 91.0%) and 92.1% (95% CI, 82.4%-97.4%), respectively. The accuracy of FOCUS was 87.6% (95% CI, 79.0%-93.7%). The area under the curve from a receiver operating characteristic curve analysis, which evaluated the EPs' rate of detecting the presence or absence of RWMAs, was 0.845 (95% CI, 0.753-0.913). Our study results suggest that EPs with training in bedside echocardiography can accurately rule in patients with RWMAs in suspected non-ST-elevation myocardial infarction cases.

Accuracy of Emergency Physicians in Diagnosis of Thoracic Aortic Dissection; a Retrospective Study Examining the Incidence and Outcome of Patients with TAD

Objective: This study is a retrospective study looking at the incidence, management and outcome of patients with thoracic aortic dissection, and the accuracy of emergency physicians in diagnosing thoracic aortic dissection. Background: Thoracic Aortic Dissection (TAD) is associated with a high mortality rate, more so if there is missed or late diagnosis (1-2% per hour). This makes the early diagnosis and prompt management a crucial component in mortality reduction. Methods: A retrospective cross-sectional data analysis of adults presenting to three Monash Health Emergency Departments (ED) suspected for TAD, over a 1-year period from 1st July 2018 to 30th June 2019. Through the presentations, patients with confirmed TAD were identified and demographics, management options as well as outcome were analysed. Results: 16045 adults presented to Monash health EDs with chest pain as their chief complaint over the study period. 68 had been investigated for TAD mainly with CT aortogram. 11 patients had a confirmed TAD (incidence rate of approximately 6.5 in 10000 patients per year), with majority (9 patients) being diagnosed with Stanford Type A dissection. Two patients died in the ED (mortality rate 18%) and others who survived were discharged home and stayed well in 3 months follow up. Conclusion: Thoracic aortic dissection, in particular Type A, remains a condition with a relatively high mortality rate. To reduce this, high index of suspicion and prompt investigation is essential. We demonstrated good accuracy and competency of Emergency physicians in diagnosing and screening for thoracic aortic dissection. Keywords: Aortic dissection; death; dissection; emergency department; TAD; Thoracic aortic dissection

Analysis of the neurology consultations in the emergency department and diagnostic accuracy of emergency physicians for the neurologic emergencies

Analysis of the neurology consultations in the emergency department and diagnostic accuracy of emergency physicians for the neurologic emergencies

What Did You Order? Developing Models to Measure the Impact of Usability on Emergency Physician Accuracy Using Computerized Provider Order Entry

Computerized Provider Order Entry (CPOE) is a critical component of electronic health records (EHR). Although widely adopted, the usability of these systems is not well understood. A cross-sectional usability study was conducted at four healthcare systems using two commercially available EHRs. This research aims to predict the accuracy of an order placed in the EHR by emergency medicine physicians. Physician-EHR interactions were recorded during six simulated task scenarios in a test environment. The data from 222 interactions were used to predict the accuracy of the order placed. Multiple models were developed, and their performance was compared. The Random Forest model had the best performance with F1 score 0.82 and AUC of 0.89. These results demonstrate the utility of using keystroke, time and user demographics as variables in predicting accurate order placement. Applying such models to passively monitor EHR usage in real world clinical environments may help improve patient safety and care.

Clinical Gestalt for Early Prediction of Delayed Functional and Symptomatic Recovery From Mild Traumatic Brain Injury Is Inadequate

Clinical Gestalt for Early Prediction of Delayed Functional and Symptomatic Recovery From Mild Traumatic Brain Injury Is Inadequate

Comparison of abdominal ct interpretation levels of emergency physicians and radiologists

Aim: Computerized tomography (CT) is a frequently used diagnostic tool in the emergency department. In order to provide early and appropriate intervention for the patients, emergency physicians should be able to accurately interpret CT images at least to a certain degree. In this study, we aimed to determine the accuracy of emergency physicians in evaluating an abdominal CT.Methods: In 2018, the images of 234 patients who underwent an abdominal CT due to trauma were interpreted by emergency physicians(EP). The level of agreement between emergency physicians and radiologists on these abdominal CT was determined by comparing their evaluations.This comparison was made using the kappa statistics.Results: The rate of concordance in CT interpretations between the EPs and radiologists was 52.1%. The accuracy rate of EP on interpretation CT images was 59.22% (95% CI: 52.18-66) and the kappa value was 0.24. For the CT interpretation of emergency physicians, the sensitivity, specificity, positive predictive value and negative predictive value were calculated as 40.98%(95% CI: 32.17-50.25), 85.71%(95% CI: 76.38-92.39), 80.65%(95% CI: 70.30-88.00) and 50%(95% CI: 45.72-54.28), respectively. Conclusion: Emergency physicians’ accuracy in interpreting CT images is not at an adequate level. The institutions in emergency medicine should organize educative programs to increase this level.

363 Emergency Physician Accuracy in Prescribing Medications to Elderly Patients With Renal Dysfunction

363 Emergency Physician Accuracy in Prescribing Medications to Elderly Patients With Renal Dysfunction

Comparison of the Accuracy of Emergency Department-Performed Point-of-Care-Ultrasound (POCUS) in the Diagnosis of Lower-Extremity Deep Vein Thrombosis

BackgroundCompression ultrasonography is the most effective diagnostic tool in the emergency department (ED) for the diagnosis of deep vein thrombosis (DVT). It has been demonstrated to be highly accurate and cost-effective. ObjectiveThe objective of this study was to determine the accuracy of emergency physicians who performed three-point compression ultrasound (US) for suspected above-knee DVT within the context of using Wells score and D-dimer. MethodThis was a prospective diagnostic test assessment of three-point ultrasound conducted in a district general hospital of patients who presented to the ED with suspected DVT of the lower limb. The accuracy of three-point ultrasound carried out by the emergency physicians was assessed by comparison of the Doppler ultrasound carried out by the Radiology Department as reference standard. The study incorporated ultrasound alongside the Wells score and D-dimer. ResultsA total of 109 patients (66.1%) had a three-point compression point-of-care ultrasound in the ED and a second ultrasound performed by the Radiology Department. Bedside three-point compression ultrasound of the lower extremity performed by physicians in the ED had a sensitivity of 93.2% (95% confidence interval [CI] 83.8–97.3%) and a specificity of 90.0% (95% CI 78.6–95.7%), with an accuracy of 91.7% (95% CI 85–95.6%). ConclusionsEmergency physicians can obtain a level of competence equivalent to that of radiologists, but it requires substantial training and practice to achieve and maintain this performance. Providers should be aware of their limitations and maintain regular training with ultrasound applications.

Diagnostic accuracy of the Extended Focused Abdominal Sonography for Trauma (E-FAST) performed by emergency physicians compared to CT

IntroductionThe diagnostic accuracy of the FAST exam performed by EM residents were shown to be similar to radiology residents. However, in the last 2 decades, an extended-FAST (E-FAST) protocol including thoracic examination to exclude pneumo- and hemothorax was introduced. The accuracy of emergency physicians (EPs) while performing E-FAST is a less studied area, especially in Europe. The aim of this study was to compare the diagnostic accuracy of the E-FAST exam performed by EM residents with the results of CT scan as a gold standard. MethodsThis was a prospective, observational, diagnostic accuracy study conducted at the ED of a Level 1 Trauma Center. All consecutive adult multiple trauma patients were eligible, and any patient in whom thoraco-abdominal CT was ordered were recruited. Unstable and unavailable patients were excluded. E-FAST examination was performed by EPs as the index test, and CT examinations reported by a blinded academic radiology faculty was the gold standard. ResultsA total of 140 patients were recruited from eligible 144 patients. The final study population was 132 for abdominal and 130 for thorax examinations. In this study, AUC of E-FAST was 0.71 for abdominal free fluid, 0.87 for pneumothorax and 1.00 for pleural effusion. The sensitivity was 42.9% and specificity was 98.4%. The +LR for abdominal free fluid was 26.8 and −LR was 0.58. ConclusionE-FAST examination has an excellent specificity. However, the sensitivity of the test is not high enough to rule-out thoraco-abdominal injuries in trauma patients when performed by EPs.

Emergency physician accuracy using ultrasonography to diagnose lateral malleolar fracture

ObjectiveMany studies in the literature related to the investigation of the sensitivity and specificity of ultrasound examinations in lateral malleolar fractures is limited. The aim of this study is to investigate the sensitivity and specificity of ultrasound examinations performed by emergency physicians in fractures who are presented to the emergency department with blunt lateral malleolar trauma. MethodPatients over 18years of age who were admitted to the ED with lateral malleolar tenderness were enrolled to this study with convenience sampling. Ultrasonographic examination was performed by emergency physicians. Following the ultrasound examination, a two-sided X-ray was performed. In the case of inconsistency between the US exam and the X-ray evaluated by the emergency physician, a CT was performed on the patients. The X-ray or CT imaging evaluation of an orthopedic surgeon was accepted as the gold standard. ResultsA hundred-twenty patients were included in the study. Fractures in the lateral malleolus were detected in 47 patients. The sensitivity of X-ray in the diagnosis of lateral malleolar fractures was 92.8%, (95% CI, 79.4–98.1) and the specificity was 100% (95% CI, 89.5–100), while the sensitivity of US exam was 100% (95% CI, 94.1–100), and the specificity was 93% (95% CI, 85–97.6). X-ray gave false negative results in 3 patients, whereas US gave false positive results in 5 patients. ConclusionIn patients admitted to ED with lateral malleolus tenderness, the sensitivity of the ultrasound examination performed by emergency physicians regarding diagnosis of lateral malleolar fracture is higher than X-ray.

The Accuracy of Emergency Physicians in Ultrasonographic Screening of Acute Appendicitis; a Cross Sectional Study.

Diagnostic values reported for ultrasonographic screening of acute appendicitis vary widely and are dependent on the operator's skill, patient's gender, weight, etc. The present study aimed to evaluate the effect of operator skill on the diagnostic accuracy of ultrasonography in detection of appendicitis by comparing the results of ultrasonography done by radiologists and emergency physicians. This prospective diagnostic accuracy was carried out on patients suspected to acute appendicitis presenting to EDs of 2 hospitals. After the initial clinical examinations, all the patients underwent ultrasonography for appendicitis by emergency physician and radiologist, respectively. The final diagnosis of appendicitis was based on either pathology report or 48-hour follow-up. Screening performance characteristics of appendix ultrasonography by emergency physician and radiologist were compared using STATA 11.0 software. 108 patients with the mean age of 23.91 ± 7.46 years were studied (61.1% male). Appendicitis was confirmed for 37 (34.26%) cases. Cohen's kappa coefficient between ultrasonography by the radiologist and emergency physician in diagnosis of acute appendicitis was 0.51 (95% CI: 0.35 - 0.76). Area under the ROC curve of ultrasonography in appendicitis diagnosis was 0.78 (95% CI: 0.69 - 0.86) for emergency physician and 0.88 (95% CI: 0.81 - 0.94) for radiologist (p = 0.052). Sensitivity and specificity of ultrasonography by radiologist and emergency physician in appendicitis diagnosis were 83.87% (95% CI: 67.32 - 93.23), 91.5% (95% CI: 81.89 - 96.52), 72.97% (95% CI: 55.61 - 85.63), and 83.10% (95% CI: 71.94 - 90.59), respectively. Findings of the present study showed that the diagnostic accuracy of ultrasonography carried out by radiologist (89%) is a little better compared to that of emergency physician (80%) in diagnosis of appendicitis, but none are excellent.

Emergency physician accuracy in interpreting electrocardiograms with potential ST-segment elevation myocardial infarction: Is it enough?

Electrocardiogram (ECG) interpretation is widely performed by emergency physicians. We aimed to determine the accuracy of interpretation of potential ST-segment elevation myocardial infarction (STEMI) ECGs by emergency physicians. Thirty-six ECGs resulted in putative STEMI diagnoses were selected. Participants were asked to focus on whether or not the ECG in question met the diagnostic criteria for an acutely blocked coronary artery causing a STEMI. Based on the coronary angiogram, a binary outcome of accurate versus inaccurate ECG interpretation was defined. We computed the overall sensitivity, specificity, accuracy and 95% confidence intervals (95%CIs) for ECG interpretation. Data on participant training level, working experience and place were collected. 135 participants interpreted 4603 ECGs. Overall sensitivity to identify 'true' STEMI ECGs was 64.5% (95%CI: 62.8-66.3); specificity in determining 'false' ECGs was 78% (95%CI: 76-80.1). Overall accuracy was modest (69.1, 95%CI: 67.8-70.4). Higher accuracy in ECG interpretation was observed for attending physicians, participants working in tertiary care hospitals and those more experienced. The accuracy of interpretation of potential STEMI ECGs was modest among emergency physicians. The study supports the notion that ECG interpretation for establishing a STEMI diagnosis lacks the necessary sensitivity and specificity to be considered a reliable 'stand-alone' diagnostic test.

Recognizing Acute Appendicitis Criteria on Abdominal CT: Do Emergency Physicians Need a Preliminary Report?

BackgroundComputed tomography (CT) is invaluable for the diagnosis of acute appendicitis (AA) in the emergency setting when used appropriately with proper risk stratification. The aim of this study is to investigate the capability and accuracy of emergency physicians (EPs) at recognizing AA criteria in intravenous contrast-enhanced abdominal CT and to investigate the level of interobserver agreement among them. MethodsConsecutive patients who presented to İzmir University Hospital from January 1, 2014, to December 31, 2014, were evaluated. Patients with histopathologically confirmed AA and had intravenous contrast-enhanced abdominal CT were enrolled. Abdominal CT were interpreted by 4 EPs in a blind fashion. To compare differences in performances between observers, sensitivity, specificity, positive predictive value, negative predictive value, and κ values were calculated. The results were then compared with the radiology department's official reports. ResultsThere were 48 patients eligible for the study. Among these patients, 19 were male (41%), with a mean age of 34.4 years (±11.3 years). Five patients were CT-negative appendicitis according to official radiology reports that were accepted as the criterion standard. The best sensitivity and negative predictive values were achieved at criterion "enlargement of the appendix," whereas the least sensitivity was for criterion "lack of opacification in an enlarged appendix." ConclusionsThe recognition of the CT criteria for AA among EPs is substantial at best, and their ability to recognize the primary criteria for diagnosing AA is good. Emergency physicians have to gain a higher level of expertise to use this invaluable diagnostic tool more efficiently.

Clinical findings provide criteria to evaluate priorities of ophthalmologic intervention in conscious multiple trauma patients

IntroductionMultiple trauma patients frequently suffer eye injuries, especially those patients with head traumas. We evaluated the accuracy of physical findings to determine the priorities of emergency ophthalmologic intervention in these patients. Patients and methodsThis study included all multiple trauma patients with ophthalmic trauma who had a GCS of 15 when they arrived at the emergency department during the period of March, 2008–March, 2009. First, we evaluated the patients according to the criteria of the study. Then, an ophthalmologist evaluated them. ResultFrom March 2008–March 2009, 306 multiple trauma patients with ocular trauma came to our ED. The sensitivity and accuracy of emergency physicians in diagnosing the priority of ophthalmologic treatment were comparable to an ophthalmologist (measure of agreement in kappa=0.967). DiscussionThe ability of an emergency physician or general surgeon to determine the actual need of early ophthalmologist intervention can improve decision making and saving both time and money. Our study suggests that it is possible to determine according to clinical findings the need of the patient to have ophthalmologic intervention without referring the patient to ophthalmologist examination. ConclusionDefining specific criteria of ophthalmologic examinations can clarify the necessity of emergency ophthalmologic examination and intervention.

Accuracy of Non-Contrast CT Brain Interpretation by Emergency Physicians: Acohort study.

To assess the accuracy of emergency physicians (EPs) in the interpretation of non-contrast CT Brain (NCCT Brain) by examining the inter rater reliability between EPs and radiology specialists. A four months prospective cohort study was conducted at emergency department of King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. We studied the daily performance of our EPs, and compared it to the radiological report issued within the week after. Data were analyzed by calculating sensitivity, specificity, accuracy and agreement (kappa statistic), using radiology report as the reference standard. Results : Out of 241 cases eligible for the study, 210 (87.14%) were concordant, and 31 (12.86%) were discordant. The agreement (kappa) was to be 0.64. Conclusion : We concluded that our EPs are moderately accurate at interpreting NCCT Brain studies. Further education and training programs were necessary for all our EPs to improve the accuracy. Further studies are required to determine the most cost-effective method of minimizing consequential misinterpretations.