Accuracy Of Junior Doctor Plain Trauma X-Ray Interpretation: A Systematic Review And Meta Analysis

Abstract

Background Plain radiography remains a first-line assessment tool for emergency departments’ trauma patients. Given the urgency of trauma care, emergency department doctors, including junior doctors, often perform initial trauma X-ray interpretations to support timely patient management when there is an unavailability of an immediate radiologist report. However, trauma X-ray interpretation is challenging, and inaccuracies can impact patient care. This study evaluates the diagnostic accuracy of emergency department junior doctors on the initial interpretation of trauma X-rays by systematically reviewing and meta-analysing existing research on the subject. Method Studies were identified from PubMed, Scopus, Embase, Cochrane Library, and by checking the reference lists of relevant studies. Quality assessment of included studies was evaluated using the QUADAS-2 tool. Meta-analysis was conducted using bivariate models, with summary estimates reported as sensitivity, specificity, and the SROC. Meta-regression and subgroup analysis was performed to evaluate the sources of heterogeneity. Publication bias was assessed using Deeks’ funnel plot. Results Seven studies were included in this meta-analysis. Across the studies, pooled sensitivity, specificity and area under the receiver operating characteristic curve (AUC) were 0.65 (95% CI = 0.47–0.80), 0.89 (95% CI = 0.77–0.95), and 0.86 (95% CI = 0.83–0.89), respectively. Covariate analysis per anatomical region of trauma X-rays showed that for skeletal region, pooled sensitivity, specificity, and AUC were 0.72 (95% CI = 0.55–0.85), 0.86 (95% CI = 0.73–0.93), and 0.87 (95% CI = 0.83–0.89), respectively and for appendicular region, pooled sensitivity, specificity and AUC were 0.68 (95% CI = 0.49–0.82), 0.82 (95% CI = 0.62–0.93), and 0.81 (95% CI = 0.77–0.84), respectively. Substantial heterogeneity was identified but was not due to a threshold effect (Spearman rho = 0.29(p = 0.49)). Meta-regression and subgroup analysis revealed that anatomical-region-specific trauma X-ray interpretation and accuracy assessment techniques influenced heterogeneity. No publication bias was identified (p = 0.41). Conclusion Emergency department junior doctors’ accuracy in the initial interpretation of trauma X-rays was moderate. The findings further suggest a high likelihood of missed abnormalities when they interpret trauma X-rays.