Article Data

  • Views 497
  • Dowloads 187

Original Research

Open Access

Assessment of pediatric emergency physicians' interpretation of brain non-contrast computed tomography: a prospective study in a tertiary care center

  • Hashim M. Bin Salleeh1,*,
  • Mohammed A. Alrowayshed1
  • Anas A. Althenayan1
  • Ahmed Mohammed A Alkhars2
  • Rakan S. Shaheen2
  • Zohair Al Aseri3,4,5

1Department of Emergency Medicine, College of Medicine, King Saud University, 11461 Riyadh, Saudi Arabia

2College of Medicine, Dar Al Uloom University, 13314 Riyadh, Saudi Arabia

3Department of Emergency Medicine and Critical Care, College of Medicine, King Saud University, 11461 Riyadh, Saudi Arabia

4Department of Clinical Sciences, College of Medicine and Riyadh Hospital, Dar Al Uloom University, 13314 Riyadh, Saudi Arabia

5Therapeutic Deputyship, Ministry of Health, 12382 Riyadh, Saudi Arabia

DOI: 10.22514/sv.2024.077

Submitted: 28 December 2023 Accepted: 12 March 2024

Online publish date: 19 June 2024

*Corresponding Author(s): Hashim M. Bin Salleeh E-mail:


This study aims to prospectively assess the proficiency of pediatric emergency physicians (PEPs) in interpreting non-contrast computed tomography (NCCT) brain images. A prospective investigation was conducted at the pediatric emergency unit of King Saud University Medical City (KSUMC), Saudi Arabia, over a one-year period. All patients undergoing plain brain NCCT during this period were enrolled. An independent attending neuroradiologist and two certified pediatric emergency consultants compared the interpretations of PEPs with the official final reports issued by the on-call radiologist. A total of 202 pediatric patients were examined, all under 14 years of age, with a mean age of 4.8 ± 3.6 years. Trauma was the predominant presenting complaint (127 patients, 62.9%), followed by seizures (28 patients, 13.9%). The primary indication for brain NCCT was to detect intracranial bleeding, identified in 134 patients (66.3%), followed by a space-occupying lesion in 22 patients (10.9%). Additionally, hydrocephalus with elevated intracranial pressure (ICP) was observed in 20 patients (9.9%). The overall agreement between PEPs and radiologists, based on Landis and Koch benchmark classification, was moderate (Kappa = 0.578), with an accuracy of 82.18%. The overall accuracy of brain NCCT interpretation by PEPs compared to radiologists was found to be moderate. Further multicenter studies in pediatric emergency settings with larger sample sizes are warranted to validate these findings.


Emergency medicine; Computed tomography; Pediatric emergency physician; Radiologist

Cite and Share

Hashim M. Bin Salleeh,Mohammed A. Alrowayshed,Anas A. Althenayan,Ahmed Mohammed A Alkhars,Rakan S. Shaheen,Zohair Al Aseri. Assessment of pediatric emergency physicians' interpretation of brain non-contrast computed tomography: a prospective study in a tertiary care center. Signa Vitae. 2024.doi:10.22514/sv.2024.077.


[1] Gajurel I, Shakya YL, Neupane RP, Shrestha B, Gupta S, Karki S. Head computed tomography findings in relation to red flag signs among patients presenting with non-traumatic headache in the emergency services. Journal of Patan Academy of Health Sciences. 2021; 8: 79–86.

[2] Sert ET, Mutlu H, Kokulu K. The use of PECARN and CATCH rules in children with minor head trauma presenting to emergency department 24 hours after injury. Pediatric Emergency Care. 2022; 38: e524–e528.

[3] Vonk S, Leermakers J, Logtenberg SJ, Sankatsing SU. Factors associated with emergency department length of stay of internal medicine patients. Emergency Care Journal. 2021; 17: 9570.

[4] Khan A, Qashqari S, Al-Ali AA. Accuracy of non-contrast CT brain interpretation by emergency physicians: a cohort study. Pakistan Journal of Medical Sciences. 2013; 29: 549–553.

[5] Al Aseri Z, Al Aqeel M, Aldawood B, Albadr F, Ghandour R, Al Mulaik A, et al. Accuracy of brain computed tomography diagnosis by emergency medicine physicians. Computational Intelligence and Neuroscience. 2022; 2022: 5659129.

[6] Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33: 159–174.

[7] Knuckey NW, Stokes BAR. Subarachnoid haemorrhage: epidemiology, natural history, and surgical treatment. Medical Journal of Australia. 1981; 2: 651–654.

[8] Spazzapan P, Krašovec K, Velnar T. Risk factors for bad outcome in pediatric epidural hematomas: a systematic review. Chinese Neurosurgical Journal. 2019; 5: 19.

[9] Jayawant S, Parr J. Outcome following subdural haemorrhages in infancy. Archives of Disease in Childhood. 2007; 92: 343–347.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.3 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time