An analysis of the structure and brevity of preliminary clinical evaluations describing traumatic abnormalities on extremity x-ray images

Abstract

Introduction: The preliminary clinical evaluation (PCE) system involves the radiographer providing an immediate comment highlighting an abnormality on the x-ray image. This can be a valuable service development though it must be recognised that the structure of the PCE may impede its usefulness. This study aimed to assess radiographers' ability to form a concise description of radiographic abnormalities by evaluating their structure and brevity.

Method: A convenience sampling approach was used and the study was open to all radiographers (n = 48) in a United Kingdom (UK) hospital. Participants provided a PCE for 35 abnormal appendicular cases, which were assessed for the number of words used, lexical density and Gunning-Fog index; comparisons were made with a gold standard. PCE accuracy was evaluated with a scoring system and statistical analysis was completed with SPSS.

Results: 21 participants took part. The mean (SD,range) words used was greater than the gold standard (9.5 (3.89,14.9) vs 5.6 (1.46,7)). The mean (SD,range) lexical density was lower than the gold standard (73.8 (4.02,20.1) vs 100 (0,0)), and the mean Gunning-Fog index was also lower (15.1 (3.79,18.3) vs 20.7 (6.82,22.6)). The mean (SD,range) PCE score was 2.8 (0.34,1.17), compared to 5 (0,0) for the gold standard, and this was a statistically significant difference (t (21) = -29,p = .001).

Conclusion: Participants used too many words in their PCE comments with reduced descriptive content that did not match the reading level of the gold standard. Areas for suggested improvement in practice include introduction of a comment-forming model with additional education. These findings provide an interesting addition to the growing PCE knowledge base.

Implications for practice: Dedicated training prior to implementation and participation, to standardise comment structure, could improve the effectiveness of the PCE system.