Literature review of studies on the effectiveness of nurses ability to order and interpret X-rays

Background: The role of radiography within the context of the emergency department (ED) is to aid the physician in the accurate clinical diagnosis of trauma or illness and traditionally, the responsibility for interpreting radiographic images has been with medical physicians. X-rays should be used in tandem with other clinical information to confirm or deny a diagnosis and the role of ordering and interpreting X-rays is now within the scope of the emergency nurse practitioners (NPs). Methods: The purpose of this review was to examine the available evidence defining the ability of emergency NPs to appropriately order and interpret radiographs. A literature search was performed to identify papers on emergency NP X-ray accuracy and appropriateness compared to medical physicians. Results: A total of 58 publications were identified, and of these 50 papers had no direct relevance to emergency NPs. The eight studies concluded that advanced specially trained nurses are able to order and interpret X-rays to a level comparable to that of their medical colleagues. However, there was a lack of homogeneity in the level of experience of practitioners examined. The physician level of experience reported was from junior doctors to registrar and consultant level and nurses were not always NPs but categorized by years of experience in ED. Methods described included rating scales, benchmarking against radiologists, specificity and sensitivity and auditing techniques. The numbers of X-rays used in each studied also varied greatly from 30 to 2000 radiographs and the majority of studies were performed in the United Kingdom. Overall with the nurses' interpretations, the rate of false negatives and false positives was low. Conclusions: From the studies examined, it is difficult to extrapolate an acceptable level or standard for nurse practitioners from this research and clearly further research needs to be performed, especially in the local context.