INTERPRETATION OF TRAUMA RADIOGRAPHS BY JUNIOR DOCTORS IN ACCIDENT AND EMERGENCY DEPARTMENTS - A CAUSE FOR CONCERN

Objectives-To investigate how well junior doctors in accident and emer gency (A&E) were able to diagnose significant x ray abnormalities afte r trauma and to compare their results with those of more senior doctor s. Methods-49 junior doctors (senior house officers) in A&E were teste d with an sc ray quiz in a standard way. Their results were compared w ith 34 consultants and senior registrars in A&E and radiology, who wer e tested in the same way. The quiz included 30 x rays (including 10 no rmal films) that had been taken after trauma. The abnormal films all h ad clinically significant, if sometimes uncommon, diagnoses. The resul ts were compared and analysed statistically. Results-The mean score fo r the abnormal x rays for all the junior doctors was only 32% correct. The 10 junior doctors with more experience scored significantly bette r (P < 0.001) but their mean score was only 48%. The mean score of the senior doctors was 80%, which was significantly higher than the junio rs (P < 0.0001). Conclusions-The majority of junior doctors misdiagnos ed significant trauma abnormalities on sc ray. Senior doctors scored w ell, but were not infallible. This suggests that junior doctors are no t safe to work on their own in A&E departments. There are implications for training, supervision, and staffing in A&E departments, as well a s a need for fail-safe mechanisms to ensure adequate patient care and to improve risk management.