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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. This highlights the need for support strategies to enhance their diagnostic accuracy to strengthen clinical decision-making in trauma care.

Publication Type:	Article
Additional Information:	This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Publisher Keywords:	Diagnostic accuracy, Emergency department, Junior doctors, Meta-analysis, Traumatic injury, X-ray interpretation
Subjects:	R Medicine > RC Internal medicine
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Allied Health
SWORD Depositor:	Symplectic Administrator

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