Table 2.
Checkpoints for the interpretation of each region and definitions
Checkpoint |
Head |
Skull fracture, Basal skull fracture, Brain contusion, Intracranial hemorrhage, Subarachnoid hemorrhage, Subdural hemorrhage, Epidural hemorrhage, Vascular injury |
|
Face |
Bone injury (Ophthalmology wall, Maxilla, Mandible, Zygomatic, Nose), Eyeball injury, Optic nerve injury, Vascular injury (if enhanced) |
|
Neck |
Bone injury (Cervical spine, Spinous process, Transverse process), Pharyngeal injury, Bronchial injury, Vascular injury (if enhanced) |
|
Chest |
Bone injury (Rib, Clavicle, Scapula, Sternum), Thoracic spine injury, Pneumothorax, Hemothorax Pulmonary injury, Bronchial injury, Cardiac injury, Cardiac tamponade, Esophageal injury Diaphragmatic injury, Vascular injury (if enhanced) |
|
Abdomen |
Bone injury (Lumber spine), Parenchymal organ injury (Liver, Gallbladder, Pancreas, Spleen, Kidney, Adrenal gland), Digestive tract injury, Free air, Mesenteric injury, Ureteral injury, Vascular injury (if enhanced) |
|
Pelvis |
Bone injury (Lumber spine, Ilium, Sacrum, Pubis, Ischium, Acetabular cartilage, Femur), Bladder injury, Urinary tract injury, Genital organ injury, Vascular injury (if enhanced) |
Definition of misinterpretation | ||
No misinterpretation |
All checkpoints were accurately cleared. |
|
Minor misinterpretation |
Anatomical abnormalities were identified, but details were incomplete or incorrect. (e.g., rib fracture was identified but the injured number was misinterpreted; brain injury was pointed out, but the correct diagnosis such as subdural hemorrhage was not recorded.) |
|
Major misinterpretation |
Anatomical abnormality described on CT was apparently missed even if EP received support by radiologist. |
|
Gravity level |
The gravity level was determined upon review of the patient’s clinical course. |
|
|
Level 1 |
Clinical course was not affected by the EP’s interpretation. |
|
Level 2 |
Clinical course was affected by the EP’s misinterpretation. |
|
|
1) More invasive treatment was required because of the delayed detection of organ injuries. |
|
|
2) Temporary functional disorders or persistent cosmetic problems |
|
|
3) The course of treatment was unavoidably changed. |
|
|
4) Hospital stay was prolonged. |
|
Level 3 |
Clinical prognosis was seriously affected by the EP’s misinterpretation. |
|
|
1) Permanent, severe functional disorders or cosmetic problems (e.g., persistent disorder of consciousness, limb palsy, large scars) |
2) Death |
Checkpoints for each region were established in accordance with the Abbreviated Injury Scale (AIS).