Interpretation Of Pneumothorax On Emergency Department Chest Radiographs By Emergency Physicians and Residents

OBJECTIVE: Pneumothorax is defined as the entry of air into the pleural space, and may cause mortal complications when diagnose and treatment delay. The diagnosis is made on an erect posteroanterior chest xray which shows an edge cased by visceral pleura and absence of lung markings beyond this edge. These chest radiographs are initially interpreted by an emergency physician and decisions are made on the basis of this initial interpretation.
METHODS: The chest radiographs of 100 patients were collected from PACS archive.50 of these radiographs were reported as normal and 50 of them were pneumothorax. Emergency clinicians participating in the study included four emergency medicine physicians, three final year residents( senior), four intermediate year residents( middle-senior) and four first year residents(junior).Each physician interpreted 100 radiograph. Effects of interobserver variability and degree of pneumothorax on diagnosing pneumothorax on chest x-ray were investigated. Chest radiographs were re-interpreted 2 weeks later to search intraobserver variability.
RESULTS: The accuracy of the emergency department physicians and residents on diagnosing complete pneumothorax were %100, intermediate pneumothorax were %95.1, small pneumothorax were %49.7. Final year residents correctly diagnosed %83.3, intermediate year residents %75.5, first year residents %62.5.
CONCLUSION: Increase in the volume of pneumothorax made it easier to diagnose on chest radiograph. Residency year is associated with correct diagnose of pneumothorax especially in small pneumothorax cases.