Factors associated with junior doctor plain trauma X-ray interpretation accuracy and strategies for improvement: a scoping review

Background: Plain radiography is a key diagnostic tool for trauma patients in emergency departments, often requiring immediate interpretation so that urgent care is not delayed. Due to difficulty in accessing timely radiologist reports and the demand for rapid decision-making, emergency department doctors, including junior doctors, have, over the years, been involved in the initial interpretation of plain trauma X-rays. However, concerns remain about the accuracy of these junior doctors, which may impact patient safety. Despite its significance, there’s a notable gap in knowledge on the factors that influence their accuracy and strategies to improve their accuracy. This review explored these specific factors and strategies. Method: A scoping review was conducted following the framework by Arksey and O’Malley as updated by Levac, Colquhoun, and O’Brien. Searches were performed in PubMed, SCOPUS, Embase, Cochrane Library, Google Scholar and through reference list search of eligible studies from a timeframe of 1985 to August 2025. A narrative approach was employed to describe findings after content analysis of eligible studies. Results: Nine articles were ultimately included. The factors identified were emergency department clinical experience, anatomical site-specific interpretation, radiographic image-related factors, time and mechanism of traumatic injury. Further, plain trauma X-ray interpretation training, emergency department clinical experience with a teaching programme and collaboration with radiographers were identified as potential accuracy improvement strategies. Conclusion: Junior doctors’ plain trauma X-ray interpretation accuracy was influenced by several factors. Strategies like training, increased exposure to trauma X-rays in the emergency department with structured teaching programmes, and enhanced collaboration with radiographers can help mitigate the risk of misinterpretations among junior doctors. Future studies should not only validate these findings and investigate additional influencing factors and strategies, but also examine potential barriers to implementing such strategies. Clinical trial number: Not applicable.