Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Aug;36(8):485-492.
doi: 10.1136/emermed-2018-207842. Epub 2019 Jun 24.

Impact of emergency physician experience on decision-making in patients with suspected community-acquired pneumonia and undergoing systematic thoracic CT scan

Josselin Le Bel  1   2 , Thierry Pelaccia  3   4 , Patrick Ray  5 , Charles Mayaud  6 , Anne-Laure Brun  7 , Pierre Hausfater  8   9 , Enrique Casalino  9 , Mikhael Benjoar  7 , Yann-Erick Claessens #  10 , Xavier Duval #  2   11 ; ESCAPED study group
Collaborators, Affiliations

Impact of emergency physician experience on decision-making in patients with suspected community-acquired pneumonia and undergoing systematic thoracic CT scan

Josselin Le Bel et al. Emerg Med J. 2019 Aug.

Abstract

Objectives: To determine whether the impact of a thoracic CT scan on community-acquired pneumonia (CAP) diagnosis and patient management varies according to emergency physician's experience (≤10 vs >10 years).

Methods: Early thoracic CT Scan for Community-Acquired Pneumonia at the Emergency Department is an interventional study conducted from November 2011 to January 2013 in four French emergency departments, and included suspected patients with CAP. We analysed changes in emergency physician CAP diagnosis classification levels before and after CT scan; and their agreement with an adjudication committee. We performed univariate analysis to determine the factors associated with modifying the diagnosis classification level to be consistent with the radiologist's CT scan interpretation.

Results: 319 suspected patients with CAP and 136 emergency physicians (75% less experienced with ≤10 years, 25% with >10 years of experience) were included. The percentage of patients whose classification was modified to become consistent with CT scan radiologist's interpretation was higher among less-experienced than experienced emergency physicians (54.2% vs 40.2%; p=0.02). In univariate analysis, less emergency physician experience was the only factor associated with changing a classification to be consistent with the CT scan radiologist's interpretation (OR 1.77, 95% CI 1.01 to 3.10, p=0.04). After CT scan, the agreement between emergency physicians and adjudication committee was moderate for less-experienced emergency physicians and slight for experienced emergency physicians (k=0.457 and k=0.196, respectively). After CT scan, less-experienced emergency physicians modified patient management significantly more than experienced emergency physicians (36.1% vs 21.7%, p=0.01).

Conclusions: In clinical practice, less-experienced emergency physicians were more likely to accurately modify their CAP diagnosis and patient management based on thoracic CT scan than more experienced emergency physicians.

Trial registration number: NCT01574066.

Keywords: emergency care systems, advanced practitioner; emergency care systems, emergency departments; imaging, Ct/mri; pneumonia/infections.

PubMed Disclaimer

Conflict of interest statement

Competing interests: JLB reports grants from Pfizer, outside the submitted work. Y-EC reports grants from the French Ministry of Health, during the conduct of the study, and reports grants from Biomerieux, Sanofi and Bayer, outside the submitted work. XD reports grants from the French Ministry of Health, during the conduct of the study, and reports grants from Pfizer, outside the submitted work.

Figures

Figure 1
Figure 1
Level of CAP diagnosis classification: evaluation of agreement between emergency physicians classification and radiologists’ classification or adjudication committee classification before and after thoracic CT scan. CAP, community-acquired pneumonia.
Figure 2
Figure 2
Patients classification before and after thoracic CT scan according to CT scan interpretation by radiologist.
See this image and copyright information in PMC

References

    1. Croskerry P. Critical thinking and decisionmaking: avoiding the perils of thin-slicing. Ann Emerg Med 2006;48:720–2. 10.1016/j.annemergmed.2006.03.030 - DOI - PubMed
    1. Gennis P, Gallagher J, Falvo C, et al. . Clinical criteria for the detection of pneumonia in adults: guidelines for ordering chest roentgenograms in the emergency department. J Emerg Med 1989;7:263–8. 10.1016/0736-4679(89)90358-2 - DOI - PubMed
    1. Metlay JP, Fine MJ. Testing strategies in the initial management of patients with community-acquired pneumonia. Ann Intern Med 2003;138:109–18. 10.7326/0003-4819-138-2-200301210-00012 - DOI - PubMed
    1. Mandell LA. Epidemiology and etiology of community-acquired pneumonia. Infect Dis Clin North Am 2004;18:761–76. 10.1016/j.idc.2004.08.003 - DOI - PMC - PubMed
    1. Albaum MN, Hill LC, Murphy M, et al. . Interobserver reliability of the chest radiograph in community-acquired pneumonia. PORT Investigators. Chest 1996;110:343–50. 10.1378/chest.110.2.343 - DOI - PubMed

MeSH terms

Associated data