Interpretation of Pneumothorax on Emergency Department Chest Radiographs by Emergency Physicians and Residents

Abstract

Aim: Pneumothorax is defined as the entry of air into the pleural space, which may cause mortal complications when delayed in diagnosis and treatment. The diagnosis is made on an erect posteroanterior chest X-ray that shows an edge caused 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. Materials and Methods: The chest radiographs of 100 patients were collected from the PACS archive. Fifty 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 radiographs. The effects of interobserver variability and degree of pneumothorax on diagnosing pneumothorax on chest X-ray were investigated. The chest radiographs were re-interpreted 2 weeks later to identify intraobserver variability. Results: The accuracy of the emergency department physicians and residents on diagnosing complete pneumothorax was 100%, intermediate pneumothorax was 95.1%, and small pneumothorax was 49.7%. The rate of correct diagnosis among final-year, intermediate-year, and first-year residents was 83.3%, 75.5%, and 62.5% of the radiographs, respectively. Conclusion: The increase in the volume of pneumothorax rendered easy diagnosis chest radiograph. The residency year is associated with correct diagnose of pneumothorax especially in small pneumothorax cases.