Emergency radiology
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Emergency radiology · Jun 2015
Does early ED CT scanning of afebrile patients with first episodes of acute pancreatitis ever change management?
Rising utilization of computed tomography (CT) imaging early in the course of acute pancreatitis (AP) has been recently reported. However, radiographic demonstration of the degree of necrosis or the presence of complications is not fully apparent within the first days of an acute attack. The objective of this study was to examine if CT scanning early in the course of disease (<48 h of symptoms) in afebrile patients with an emergency department (ED) diagnosis of first episode of AP revealed any unanticipated pathology that altered clinical management. ⋯ No patient that underwent CT scanning had an unexpected finding (95 % CI, 0.923-1.0). Our results demonstrate that afebrile patients with first episodes of AP do not benefit from early abdominal CT imaging. These results support the ACR Appropriateness Criteria recommendation that CT is not indicated in the first 48 h after symptom onset in unequivocal cases of AP.
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Emergency radiology · Apr 2015
Evaluation of a sequential multi-modality imaging algorithm for the diagnosis of acute appendicitis in the pregnant female.
The purpose of this study is to evaluate the performance of a sequential multi-modality imaging algorithm for diagnosing acute appendicitis in pregnancy. This IRB-approved, HIPAA compliant study included 127 consecutive pregnant patients imaged for suspected appendicitis between October 2007 and May 2012; all patients initially underwent ultrasound (US) examination, followed by magnetic resonance imaging (MRI) if results of US were negative or equivocal. Computerized tomography (CT) was reserved for cases with inconclusive US and MRI results. ⋯ The diagnostic performance of this sequential multi-modality imaging algorithm for diagnosing acute appendicitis in pregnancy is high. Given the low yield of US, MRI should be considered the first-line imaging test. Although CT was employed in a small fraction of inconclusive MRI examinations, it still has a role in the diagnostic work-up of the pregnant patient with suspected appendicitis.
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Emergency radiology · Feb 2015
Case ReportsIntraoperative 3D rotational angiography: an emergency tool for the diagnosis of intracranial aneurysms.
It was the objective of this report to present a case of recurrent aneurysmal subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) in which an MCA aneurysm was detected by 3D rotational fluoroscopy in an emergency situation. A 44-year-old woman was admitted from an external department after repeated SAH and temporal ICH. Due to progressive anisocoria and cardiocirculatory instability, she was transferred to the operating room without angiography. ⋯ The entire procedure from positioning of the fluoroscope to the production of utilizable 3D images was completely integrated into the surgical workflow with an image acquisition time of 2 × 24 s. The configuration of the aneurysm, the aneurysm-carrying vessel, and the distal vessel anatomy were well assessable. This technique quickly supplies images at adequate quality to assess the configuration of an intracranial aneurysm and is a useful diagnostic tool if the patient's critical condition prohibits aneurysm diagnostics by angiography or CT angiography.
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Emergency radiology · Feb 2015
Can non-contrast-enhanced CT (NECT) triage patients suspected of having non-traumatic acute aortic syndromes (AAS)?
This work was conducted to determine whether non-contrast-enhanced CT (NECT) of patients with suspected acute aortic syndrome (AAS) can identify patients with a very low likelihood of a positive diagnosis. In the derivation phase, patients who received both NECT and contrast-enhanced CT angiography (CTA) for suspected AAS were identified. Two readers blinded to CTA results analyzed NECTs from AAS positive and negative cases, recording maximal aortic diameters and qualitative findings of aortic disease. ⋯ The decision rule incorporating these findings achieved higher mean sensitivity (93 %), negative predictive value (96 %), and moderate reader agreement (kappa = 0.59). For the validation phase, application of the decision rule to 35 AAS positive and 45 AAS negative cases at the second institution yielded sensitivity of 100 % and specificity of 74 % for both readers. NECT can identify patients with a very low likelihood of AAS and potentially mitigate the urgency of performing CTA.
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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.