Emergency radiology
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Emergency radiology · Jul 2010
Intraobserver and interobserver agreement of the interpretation of pediatric chest radiographs.
The objective of this study is to quantify the magnitude of intraobserver and interobserver agreement among physicians for the interpretation of pneumonia on pediatric chest radiographs. Chest radiographs that produced discordant interpretations between the emergency physician and the radiologist's final interpretation were identified for patients aged 1-4 years. From 24 radiographs, eight were randomly selected as study radiographs, and 16 were diversion films. ⋯ Intraobserver agreement was good for pediatric radiologists (kappa = 0.87; 95% CI 0.60-0.99) for both but was lower for senior emergency physicians (mean kappa = 0.68; 95% CI 0.40-0.95) and junior pediatric emergency physicians (mean kappa = 0.62; 95% CI 0.35-0.98). Interobserver agreement was fair to moderate overall; between pediatric radiologists, kappa = 0.51 (0.39-0.64); between senior emergency physicians, kappa = 0.55 (0.41-69), and between junior pediatric emergency medicine physicians, kappa = 0.37 (0.25-0.51). Practicing emergency clinicians demonstrate considerable intraobserver and interobserver variability in the interpretation of pneumonia on pediatric chest radiographs.
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Emergency radiology · Jul 2010
Case ReportsInferior vena cava dissection following blunt abdominal trauma.
Dissection of the inferior vena cava (IVC) is rare, with only a few published reports in the literature. It is usually associated with blunt abdominal injury or iatrogenic injury from a catheter manipulation. ⋯ However, IVC dissection is associated with a high mortality rate due to the difficulty in diagnosis, technically difficult surgical repair, and associated solid organ injuries. We report a case of IVC dissection from a low-speed motor vehicle collision and discuss its imaging features.
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Emergency radiology · Jul 2010
CT and MR imaging of primary cerebrovascular complications in pediatric head trauma.
The incidence of severe traumatic head injury in children has constantly increased over the last years. Diagnostic imaging has become an unrenounceable tool for the documentation and follow-up of intracranial lesions. The use of magnetic resonance imaging (MRI) in the early posttraumatic phase has led to a more thorough understanding of intracranial injuries. ⋯ In two patients, thrombosis of the transverse sinus appeared on MRI 4 to 6 days after the trauma. In another patient with open-skull injury, a posttraumatic aneurysm of the pericallosal artery was diagnosed on MRI 30 days after the trauma. Our study shows that, although primary cerebrovascular lesions after traumatic head injuries in children are rare, the radiologist should be aware of the characteristic injury patterns and the time appearance of imaging findings on CT and MRI.
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Emergency radiology · Jul 2010
Overuse of concomitant foot radiographic series in patients sustaining minor ankle injuries.
Radiographic series of the foot are often obtained in conjunction with ankle X-rays when the clinical presentation is limited to trauma to the ankle. The Ottawa Ankle and Foot Rules were established in 1992 and serve as reliable guidelines to determine when an ankle or foot series is warranted in patients who have sustained minor ankle and/or foot injury. We retrospectively reviewed radiographic studies of all patients over a period of 18 months who simultaneously had ankle and foot plain radiographs performed for acute complaints limited to the ankle alone. ⋯ No fractures or dislocations were noted elsewhere in the foot. All of the fifth metatarsal fractures were evident on adequately performed ankle series. Our findings suggest that films of the foot are not necessary when trauma is limited to the ankle and when an appropriately performed ankle series has been completed.
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Emergency radiology · Jul 2010
Effect of oral contrast for abdominal computed tomography on emergency department length of stay.
Computed tomography of the abdomen and/or pelvis (CTAP) is frequently used in the emergency department (ED) allowing diagnosis of a variety of conditions, but requiring a prolonged period of preparation. To determine whether not requiring oral contrast for CTAP reduces ED length of stay (LOS). Retrospective cohort of adult patients visiting an academic ED over 13 weeks around a radiology protocol change. ⋯ Among ED visits where a CTAP was performed, median time to CTAP decreased by 27 min and median LOS decreased by 30 min. Adjusted LOS decreased from 324 min (312-337) to 297 min (285-309). Not routinely requiring oral contrast for CTAP in the ED is associated with a half-hour reduction in LOS among all patients undergoing CTAP.