Introduction: Missed fractures in the Emergency Department (ED) can lead to delayed treatment and patient harm. Radiographer preliminary clinical evaluation (PCE) aims to support referrers when interpreting radiographs in the absence of a definitive clinical report. This pre-implementation study evaluated radiographer participation and diagnostic accuracy in a department without an existing radiographer abnormality detection system. Methods: A prospective service evaluation study was conducted in a general hospital. Radiographers were asked to provide PCE for consecutive ED musculoskeletal trauma radiographs. Participation was recorded. PCEs were compared with the clinical report, and sensitivity, specificity and accuracy were calculated with 95% confidence intervals. Accuracy was evaluated against a fixed performance standard using a non- inferiority test. Differences in proportions between the first and second halves of the study period, in participation and accuracy, were assessed using z-tests. Results: Of 937 eligible examinations, 412 contained a PCE comment (44.0% participation), increasing significantly from 39.3% (182/463) in the first half of the study period to 48.5% (230/474) in the second half (p = 0.0045). After exclusions, 369 PCEs were analysed. Sensitivity, specificity and accuracy were 80.2%, 94.2% and 89.3%, respectively. The lower bound of the accuracy confidence interval (85.7%) exceeded the non-inferiority margin (82% accuracy), confirming PCE accuracy was statistically non inferior to the 92% benchmark. Median time from examination attendance to PCE entry was 12 min. Conclusion: Radiographers provided timely, accurate PCEs, achieving performance comparable with published standards, demonstrating the feasibility of implementing a PCE service. Implications for practice: This study contributes to the evidence supporting PCE in departments without a 24-h hot- reporting service. Even without a dedicated training package, radiographers performed well, but this study emphasises that sensitivity remains a key area for further improvement.
Preliminary Clinical Evaluation by emergency department radiographers: Results from a pilot study benchmarking participation and diagnostic accuracy
Introduction: Jersey General Hospital is working towards implementation of a radiographer Preliminary Clinical Evaluation (PCE) system in line with new professional guidance from the Society of Radiographers. Radiographer PCE is an informed comment on imaging appearances, intended to assist the referrer in interim between image acquisition and a definitive report. The aim is to utilise the expertise and experience of radiographers in identifying normal and abnormal image findings on trauma radiographs to maximise diagnostic
accuracy. Pilot Project Objectives:• Assess radiographer PCE
participation.
• Compare PCE accuracy to a
performance standard. Methods: Study Design & Setting: Prospective diagnostic performance study comparing PCE accuracy to a fixed standard. Standard: 92% accuracy, derived from prior research. Sample size calculation: 354 PCEs were required to adequately power the study. Conclusion: In conclusion, while a recent pilot study reported a PCE participation rate of 66%, our study’s overall rate was 44%, with a notable increase to 47.9% in the latter half, suggesting improved integration of PCE into routine practice. Additionally, our
accuracy of 89.3% compares favourably against recommended benchmarks of 80% (minimal), 90% (optimal), and 95% (ideal) for interpreting musculoskeletal
radiographs, and results of recent literature.