A MULTICENTER STUDY TO IMPROVE EMERGENCY-MEDICINE RESIDENTS RECOGNITION OF INTRACRANIAL EMERGENCIES ON COMPUTED-TOMOGRAPHY

Study objective: Cranial computed tomography (CT) has assumed a critic al role in the practice of emergency medicine for the evaluation of in tracranial emergencies. Several recent studies have documented a defic iency in the emergency physician's ability to interpret these studies. The purpose of this study was to quantify the baseline ability of eme rgency medicine residents to interpret cranial CTs, and to test a nove l method of cranial CT interpretation designed for the emergency physi cian in training. Methods: A standardized pretest was administered to assess baseline ability to interpret CT scans. A standardized posttest was given 3 months after the course. Each test consisted of 12 CT sca ns with a short accompanying history. All scans were validated by 3 ex pert reviewers for difficulty and diagnosis. A 2-hour course based on the mnemonic ''Blood Can Be Very Bad'' was then administered, ''Blood' ' reminds the examiner to search for blood, ''Can'' prompts the examin er to identify 4 key cisterns, ''Be'' denotes the need to examine the brain, ''Very'' prompts a review of the 4 ventricles, and finally ''Ba d'' reminds the examiner to evaluate the bones of the cranium. Results : Eighty-three residents at 5 institutions were initially examined. Th e mean percentage correct before the course was 60% (95% confidence in terval [Cl] 58%-64%) on the standardized pretest. At retesting 3 month s after the course, the accuracy rate increased to 78% (n=61, 95% Cl 7 5%-81%, P<.001 paired t test). Conclusion: Emergency medicine resident s are deficient in their ability to interpret cranial CT scans, A nove l educational course was demonstrated to significantly improve this ab ility.