When one patient underwent a simultaneous CT scan of several body regions, the results were classified by region and analyzed separately. The evaluation of image diagnoses was performed by dividing the body into the following regions: head, face, neck, chest, abdomen, and pelvis. Checkpoints in each region were evaluated in accordance with the Abbreviated Injury Scale (AIS) (Table  2). In this study, we defined standards for the level of misinterpretation (minor versus major) and the level of gravity (effect on the patient) to evaluate how the level of misinterpretation check details influenced the clinical course of the patient (namely, we thought that a major

misinterpretation, in which an anatomic abnormality was missed, was more likely to lead to a fatal prognosis). Those definitions were designed in accordance with past reports (Table  2) [8–10]. 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), Selleckchem R428 Pharyngeal injury, buy Adriamycin 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) Glycogen branching enzyme   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.