بررسي ميزان توافق تفسيرسي‌تي‌اسكن بيماران با تروماي ستون مهره‌هاي گردني بين رزيدنت‌هاي طب اورژانس و گزارش راديولوژيست‌ها در بيمارستان شهداي هفت تير

A Study on the Agreement Rate of CT-Scan Interpretation of the Cervical Spine Trauma Patients Between the Reports of Emergency Medicine Residents and Radiologist in "Shohadaye 7Tir Hospital"

ﻫﺪف: ﺑﺮرﺳﻲ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ﺗﺒﻴﻴﻦ ﻣﻴﺰان ﺗﻮاﻓﻖ ﺗﻔﺴﻴﺮ ﺳﻲ ﺗﻲ اﺳﻜﻦ ﮔﺮدن ﺑﻴﻤﺎران ﺗﺮوﻣﺎﻳﻲ در دو ﮔـﺮوه ﻃـﺐ اورژاﻧـﺲ و رادﻳﻮﻟﻮژي ﺑﻴﻤﺎرﺳﺘﺎن ﺷﻬﺪاي ﻫﻔﺘﻢ ﺗﻴﺮ ﺗﻬﺮان اﻧﺠﺎم ﺷﺪ. ﻣﻮاد و روش ﻫﺎ: اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺗﺤﻠﻴﻠﻲ ﻣﻘﻄﻌﻲ در ﺑﻴﻤﺎرﺳﺘﺎن ﺷﻬﺪاي ﻫﻔـﺘﻢ ﺗﻴـ ﺮ در ﺷـﻬﺮ ﺗﻬـﺮان اﻧﺠـﺎم ﮔﺮﻓـﺖ ﺗﻔﺴـ ﻴﺮ 408 ﺳﻲ ﺗﻲ اﺳﻜﻦ ﻣﺮﺑﻮط ﺑﻪ ﺑﻴﻤﺎران ﺑﺎﺗﺮوﻣﺎي ﮔﺮدن ﻛﻪ ﺗﻮﺳﻂ ﮔﺮوه ﻃﺐ اورژاﻧﺲ و رادﻳﻮﻟﻮژي در ﺷﺶ ﻣﺎﻫـﻪ دوم ﺳـﺎل 1396 ﺛﺒﺖ ﺷﺪه ﺑﻮد، ﺑﺎ ﻳﻜﺪﻳﮕﺮ ﻣﻘﺎﻳﺴﻪ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ ﺑﺎ ﻛﻤﻚ ﻧﺮم اﻓﺰار SPSS ﻧﺴﺨﻪ 23 ﺑـﺎ اﺳـﺘﻔﺎده از روﺷـﻬﺎي آﻣـﺎري ﺗﻮﺻـ ﻴﻔﻲ ﺗﺠﺰﻳﻪ و ﺗﺤﻠﻴﻞ ﺷﺪ. ﺑﺮاي ﻣﺸﺨﺺ ﻛﺮدن ﻣﻴﺰان ﺗﻮاﻓﻖ ﺗﻔﺴﻴﺮﻫﺎي ﺳﻲ ﺗﻲ اﺳﻜﻦ ﮔﺮدن از ﺿﺮﻳﺐ ﻛﺎﭘﺎ (kappa) اﺳﺘﻔﺎده ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ﺑﻴﻤﺎران ﻣﺮاﺟﻌﻪ ﻛﻨﻨﺪه ﺑﺎ ﺗﺮوﻣﺎي ﮔﺮدن 8/72 ± 32/47 ﺳﺎل ﺑﻮد و 69 ﻧﻔﺮ زن و 339 ﻧﻔﺮ ﻣـﺮد )83% ﺑﻮدﻧﺪ. در 296 ﺳﻲ ﺗﻲ اﺳﻜﻦ ﺗﻔﺴﻴﺮ ﮔﺮوه ﻃﺐ اورژاﻧﺲ و رادﻳﻮﻟﻮژي ﻳﻜﺴﺎن ﺑﻮد ﻛﻪ اﻳﻦ ﺗﻌﺪاد ﺷﺎﻣﻞ 72/55 ﻣـ ﻮارد ﻣﻲ ﺷﻮد و در 112 ﻣﻮرد ﺗﺸﺨﻴﺺ ﻫﺎ ﻣﻄﺎﺑﻘﺖ ﻧﺪاﺷﺖ ﻛﻪ ﺑﺮاﺑﺮ 27/45 ﺑﻮد. در آﻧﺎﻟﻴﺰ ﺗﺤﻠﻴﻠـ ﻲ ﺿـﺮ ﻳﺐ ﻛﺎﭘـﺎ ﺑـﺮا ي ﻣﻄﺎﺑﻘـﺖ ﺗﺸﺨﻴﺺ ﻫﺎ 0/612 ﺑﻪ دﺳﺖ آﻣﺪ p<0/001 نتيجه ﮔﻴﺮي: ﺑﺎ وﺟﻮد ﻋﻤﺮ ﺟﻮان رﺷﺘﻪ ﻃﺐ اورژاﻧﺲ در ﻛﺸﻮر ﻣﺎ، ﭘﺰﺷﻜﺎن اﻳﻦ رﺷﺘﻪ ﺗﻮاﻧﺴﺘﻪ اﻧﺪ ﺑﺎ آﻣﻮﺧﺘﻦ داﻧﺶ ﻫﺎي ﻣﺮﺗﺒﻂ ﺑﺎ اورژاﻧﺲ از ﺟﻤﻠﻪ رادﻳﻮﻟﻮژي ﺗﻮاﻧﻤﻨﺪي ﻫﺎي ﺧﻮد را اﻓﺰاﻳﺶ دﻫﻨﺪ ﺗﻔﺎوﺗﻬﺎي ﻣﻮﺟﻮد در دو ﮔﺮوه، آﻣﻮزش ﭘﺎﻳﻪ و اﺻـﻮﻟ ﻲ ﺗﺮ ﻣﻔﺎﻫﻴﻢ رادﻳﻮﻟﻮژي در رﺷﺘﻪ ﻃﺐ اورژاﻧﺲ را ﮔﻮﺷﺰد ﻣﻴﻜﻨﺪ. ﺑﺮاي اﻳﻦ ﻣﻨﻈﻮر ﻣﻴﺘﻮان از ﭘﺰﺷﻜﺎن ﻣﺠﺮب ﻣﻮﺟﻮد در ﻫﻴـ ﺄت ﻋﻠﻤﻲ ﻃﺐ اورژاﻧﺲ ﻳﺎ رادﻳﻮﻟﻮژي در اﻣﺮ آﻣﻮزش ﺑﻬﺮه ﺑﺮد.

interpretations of cervical spine trauma patients between emergency medicines and radiology physicians. Materials and Methods: This cross-sectional analytical study was conducted in Shohadaye Haft-e Tir Hospital, Tehran, Iran. The 408 CT scans for patients with cervical spine trauma registered by the Emergency Medicine and Radiology physicians in the second six months of 2017, were compared. The findings were analyzed by SPSS software version 23 using descriptive statistical methods. Kappa coefficient was used to determine the agreement rate of CT scan interpretations of the cervical spine Results: The mean age of patients referring to cervical spine trauma was 32.47±8.72 years old, 69 (17%) were female and 339 (83%) were male. In 297 CT scans, the interpretation of the Emergency Medicine and Radiology residents was the same, which accounts for 725.55% of cases. In the analysis, the Kappa coefficient was 0.612 (p<0.001). Conclusion: Despite the fact that the emergency medicine is somewhat new in Iran, the emergency medicine specialists could increase their knowledge of relevant branches of medicine such as radiology. Because of the differences in interpretation, it is necessary to have additional education and radiology courses in an emergency medicine residency program. These courses can invite experienced emergency medicine or radiology department physicians.