Preliminary Clinical Evaluation: The What, Where, How Approach to Scoring

The SCoR is driving for preliminary clinical evaluation (PCE) however; currently there is no method of quantification to assess quality. FRCR has an approach to quantify comments in the rapid reporting examination (CR2B).The aim of this project was to develop a robust scoring system that enables comprehensive image evaluation regardless of profession. An image test bank was administered using RadBench with equal prevalence of normal /abnormal. A random sample of attempts was selected to pilot the scoring model. Sensitivity, specificity and accuracy were calculated. A scoring system (WWH) was developed based on the WHAT (fracture type), WHERE (location), HOW (displacement/angulation) concept (Harcus & Wright 2014) to evaluate the PCE. The results were compared to those obtained using the FRCR model. Calculated actual mean accuracy, sensitivity and specificity scores were 87%, 80% and 93% respectively. FRCR scores were 88%, 80% and 97%. WWH scores were 65%, 37%, and 93%. The FRCR score appears to mirror the actual decision scores however it does not reflect the fact that the PCE for abnormal cases is often incomplete; 'What' 67%, 'Where' 87%, 'How' 7%. The PCE score should ideally correlate with the actual score in order to provide useful information to the referring clinician. Whilst most comments state the location, less states the type, and very few refer to angulation or displacement. Analysis of the PCE is a useful indicator for targeting professional development.