Emergency radiology
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Emergency radiology · Dec 2014
Comparative StudyThe impact of introducing a no oral contrast abdominopelvic CT examination (NOCAPE) pathway on radiology turn around times, emergency department length of stay, and patient safety.
This investigation evaluates the impact of the no oral contrast abdominopelvic CT examination (NOCAPE) on radiology turn around time (TAT), emergency department (ED) length of stay (LOS), and patient safety metrics. During a 12-month period at two urban teaching hospitals, 6,409 ED abdominopelvic (AP) CTs were performed to evaluate acute abdominal pain. NOCAPE represented 70.9 % of all ED AP CT examinations with intravenous contrast. ⋯ Recall and bounce back rates were 3.2 %, and only one patient had change in impression after oral contrast CT was repeated. The NOCAPE pathway is associated with decreased radiology TAT and ED LOS metrics. The authors suggest that NOCAPE implementation in the ED setting is safe and positively impacts both radiology and emergency medicine workflow.
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Emergency radiology · Dec 2014
Utilization of a clinical prediction rule for abdominal-pelvic CT scans in patients with blunt abdominal trauma.
This study aims to determine if a clinical prediction (CP) rule to identify patients at low risk for intra-abdominal injury (IAI) is being utilized in patients undergoing abdominal computed tomography (CT) following blunt abdominal trauma. A retrospective review of adult patients with blunt abdominal trauma undergoing abdominal CT scans was performed. The CP rule was positive if any of the following were present: systolic blood pressure <90 mmHg; urinalysis >25 red blood cells/high power field; Glasgow Coma Scale score <14; abdominal tenderness; costal margin tenderness; femur fracture; hematocrit <30 %; or pneumothorax or rib fracture on chest X-ray. ⋯ In the CP rule-negative patients, IAI was identified in 1/53 (1.9 %; 95 % CI, 0, 10.1 %) and no therapeutic intervention was required. An important percentage of patients undergoing abdominal CT are not assessed for or have a negative CP rule. Improved implementation of this CP rule may reduce unnecessary abdominal CT scans in patients presenting with blunt abdominal trauma.
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Emergency radiology · Dec 2014
Patterns in computed tomography utilization among emergency physicians in an urban, academic emergency department.
We sought to determine if CT utilization rates varied by characteristics of the physician. A chart review was performed at an urban academic emergency department (ED) to identify all the CT scans ordered and patients seen for subjects 21 years of age and older by physicians between January 2001 and December 2008. "Years of experience" was defined as years of practice after residency. Various experience cutoffs were determined a priori. ⋯ Low users ordered 78 CT scans per 1,000 patient visits (95 % CI 76.6-78.5), as compared to the high users that ordered 135 CT scans per 1,000 patient visits (95 % CI 131.8-139.0). We found that all of physicians stayed within their quartiles except one. While there was substantial variation among CT utilization rates by physicians at this urban emergency department, our data shows no differences between physicians with more or less clinical experience and no change in individual utilization patterns during the study period.