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van Westendorp S, Robben SHM, van Hooft MAA, Dierckx SAA, Maas HAAM. The clinical implications of using a low threshold for computed tomography scans in older patients presenting with a proximal femur fracture. Eur Geriatr Med 2024; 15:1081-1089. [PMID: 38896388 PMCID: PMC11377457 DOI: 10.1007/s41999-024-01007-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Current guidelines recommend a low threshold for computerized tomography (CT) scanning in older patients presenting with low-energy trauma (LET). With the ageing of the population, this results in increased use of healthcare resources and costs. We aim to assess (1) the number of CT scans performed as part of the initial trauma screening, (2) their traumatic clinical implications, and (3) their non-traumatic clinical implications. METHODS A retrospective study in patients ≥ 70 years presenting at a Dutch trauma centre with a proximal femur fracture following a LET between 2021 and 2022. We collected data concerning demographics, Clinical Frailty Scale, Injury Severity Score, number of CT scans and whether the results of these scans altered clinical management. RESULTS We included 278 patients. Median age was 83.0 years (IQR 77.0-89.0), median ISS was 9 (IQR 9-10) and, most common mechanism of injury was a ground level fall (n = 159, 57.2%). In 49 patients (17.6%) one or more CT scans were performed. These scans did not reveal co-existing traumatic injuries altering clinical management. In 2 patients (0.7%) incidental findings were found that immediately affected treatment. CONCLUSION Our study concludes that (1) approximately one in five patients with a proximal femur fracture received a CT scan as part of the initial trauma screening, resulting in (2) no traumatic and (3) minimal non-traumatic clinical implications. Therefore, a restrictive policy can be justified in patients with no additional clinical signs or symptoms and admission to the hospital. Further prospective research would be valuable to confirm our results.
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Affiliation(s)
- S van Westendorp
- Department of Geriatric Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| | - S H M Robben
- Department of Geriatric Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - M A A van Hooft
- Emergency Department, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - S A A Dierckx
- Emergency Department, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - H A A M Maas
- Department of Geriatric Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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2
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Kjelle E, Andersen ER, Krokeide AM, Soril LJJ, van Bodegom-Vos L, Clement FM, Hofmann BM. Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review. BMC Med Imaging 2022; 22:73. [PMID: 35448987 PMCID: PMC9022417 DOI: 10.1186/s12880-022-00798-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate and wasteful use of health care resources is a common problem, constituting 10-34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging-in which the diagnostic test confers little to no clinical benefit-is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. METHODS A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. RESULTS A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. CONCLUSIONS A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42020208072.
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Affiliation(s)
- Elin Kjelle
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway.
| | - Eivind Richter Andersen
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Arne Magnus Krokeide
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Lesley J J Soril
- Department of Community Health Sciences and The Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Leti van Bodegom-Vos
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Fiona M Clement
- Department of Community Health Sciences and The Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
- Centre of Medical Ethics, The University of Oslo, Blindern, Postbox 1130, 0318, Oslo, Norway
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Maiman DJ, Somasundaram K, Yoganandan N, Pintar F. Importance of neural foraminal narrowing in lumbar spine fractures of low AIS severity. TRAFFIC INJURY PREVENTION 2021; 22:S140-S142. [PMID: 34714690 DOI: 10.1080/15389588.2021.1982594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE In recent years, based on injuries predicted using machine learning, there have been efforts to reduce imaging performed on trauma patients. While useful, such efforts do not incorporate results from studies investigating the pathophysiology of traumatic events. The objective of this study was to identify potentially symptomatic vertebral foramen narrowing in the presence of minor to moderate (AIS ≤ 2 levels of severity) thoracolumbar fractures sustained in motor vehicle crashes (MVCs). METHODS Hospital records and images of patients admitted to a Level One trauma center between the years 2014 and 2018 with the diagnosis of thoracolumbar fracture were reviewed. Spinal injuries were scored using the AIS v2015. In addition, the geometry of the neural foramina, particularly the height of the foramina and intervertebral disk at the posterior region, were measured using reconstructed sagittal computed tomography (CT) images. The criteria for foraminal narrowing were associated with <15 mm for the foraminal height and <4 mm for the height of the posterior disk. RESULTS 24 patients with MVCs associated thoracolumbar fractures, who met both the clinical and imaging criteria for radiculopathy and foraminal narrowing without spinal cord injury, were considered for the present clinical study. 54% of the total lumbar fracture cases reported were rated as AIS 2 injuries. AIS ≥ 3 cases reported 50% narrowing of foramen, which was expected. However, it was surprising to note that the AIS 2 cases also sustained foraminal stenosis, narrowing ranging from 13% to 20%. CONCLUSIONS Low severity (AIS ≤ 2) injuries were often found to be associated with foraminal narrowing leading to clinical complaints. While the present clinical study cannot determine if narrowing existed prior to the trauma, they were certainly asymptomatic prior to the trauma. The present findings emphasize the need for detailed imaging in all instances of thoracolumbar trauma, as clinically significant nerve compression may occur even with modest vertebral body injury.
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Affiliation(s)
- Dennis J Maiman
- Department of Neurosurgery, Medical College of Wisconsin, Mliwaukee, Wisconsin
| | | | - Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, Mliwaukee, Wisconsin
| | - Frank Pintar
- Joint Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Mliwaukee, Wisconsin
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4
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Baig A, Drabkin MJ, Khan F, Fogel J, Shah S. Patients with falls from standing height and head or neck injury may not require body CT in the absence of signs or symptoms of body injury. Emerg Radiol 2020; 28:239-243. [PMID: 32814988 DOI: 10.1007/s10140-020-01843-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the rate of clinically impactful body injury among patients who had a fall from standing height with an associated head/neck injury, but without evidence of body injury on physical exam or plain radiographs. We also examine surgical/endovascular intervention related to body injury and mortality rates for head/neck and body injury. METHODS Retrospective study of 288 patients with CT evidence of acute head/neck injury that underwent body CT despite the absence of clinical or radiographic evidence of body injury. Predictor variables were age, sex, race/ethnicity, and body mass index (BMI). RESULTS There were 11.5% (n = 33) with body injury on CT (n = 33). There were 3.1% (n = 9) with clinically impactful body injury. No patient had either surgical/endovascular intervention or mortality related to body injury. Additionally, 8.7% (n = 25) had mortality from head/neck injury. Increased age (OR = 1.05, 95% CI: 1.01, 1.08, p = 0.01) and overweight BMI (25-29.99 kg/m2) (OR = 2.85, 95% CI: 1.07, 7.62, p = 0.04) were each significantly associated with increased odds for mortality from head/neck injury. CONCLUSION Patients with falls from standing height and known head/neck injury had a low rate of clinically impactful body injury. None of the studied variables were associated with increased risk of body injury in this patient population. The low rate of clinically impactful body injury and the lack of any mortality, procedure, or transfusion resulting from body injury suggest that body CT may not be necessary in patients with head/neck injury in the absence of clinical or radiographic evidence of body injury.
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Affiliation(s)
- Asad Baig
- Department of Radiology, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA.
| | - Michael J Drabkin
- Department of Radiology, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA
| | - Fiza Khan
- Department of Radiology, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA
| | - Joshua Fogel
- Department of Business Management, Brooklyn College of the City University of New York, Brooklyn, NY, USA
| | - Salman Shah
- Department of Radiology, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA
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Roberts GJ, Jacobson LE, Amaral MM, Jensen CD, Cooke L, Schultz JF, Kinstedt AJ, Saxe JM. Cross-sectional imaging of the torso reveals occult injuries in asymptomatic blunt trauma patients. World J Emerg Surg 2020; 15:5. [PMID: 31938035 PMCID: PMC6953148 DOI: 10.1186/s13017-019-0287-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background High morbidity and mortality rates of trauma injuries make early detection and correct diagnosis crucial for increasing patient's survival and quality of life after an injury. Improvements in technology have facilitated the rapid detection of injuries, especially with the use of computed tomography (CT). However, the increased use of CT imaging is not universally advocated for. Some advocate for the use of selective CT imaging, especially in cases where the severity of the injury is low. The purpose of this study is to review the CT indications, findings, and complications in patients with low Injury Severity Scores (ISS) to determine the utility of torso CT in this patient cohort. Methods A retrospective review of non-intubated, adult blunt trauma patients with an initial GCS of 14 or 15 evaluated in an ACS verified level 1 trauma center from July 2012 to June 2015 was performed. Data was obtained from the hospital's trauma registry and chart review, with the following data included: age, sex, injury type, ISS, physical exam findings, all injuries recorded, injuries detected by torso CT, missed injuries, and complications. The statistical tests conducted in the analysis of the collected data were chi-squared, Fischer exact test, and ANOVA analysis. Results There were 2306 patients included in this study, with a mean ISS of 8. For patients with a normal chest exam that had a chest CT, 15% were found to have an occult chest injury. In patients with a negative chest exam and negative chest X-ray, 35% had occult injuries detected on chest CT. For patients with a negative abdominal exam and CT abdomen and pelvis, 16% were found to have an occult injury on CT. Lastly, 25% of patients with normal chest, abdomen, and pelvis exams with chest, abdomen, and pelvis CT scans demonstrated occult injuries. Asymptomatic patients with a negative CT had a length of stay 1 day less than patients without a corresponding CT. No incidents of contrast-induced complications were recorded. Conclusions A negative physical exam combined with a normal chest X-ray does not rule out the presence of occult injuries and the need for torso imaging. In blunt trauma patients with normal sensorium, physical exam and chest X-ray, the practice of obtaining cross-sectional imaging appears beneficial by increasing the accuracy of total injury burden and decreasing the length of stay.
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Affiliation(s)
- Gregory J Roberts
- 1Trauma Department, St. Vincent Indianapolis Hospital, 8240 Naab Road #100, Indianapolis, IN 46260 USA
| | - Lewis E Jacobson
- 1Trauma Department, St. Vincent Indianapolis Hospital, 8240 Naab Road #100, Indianapolis, IN 46260 USA
| | - Michelle M Amaral
- 2Department of Economics, University of the Pacific, Stockton, CA USA
| | - Courtney D Jensen
- 2Department of Economics, University of the Pacific, Stockton, CA USA
| | - Louis Cooke
- 1Trauma Department, St. Vincent Indianapolis Hospital, 8240 Naab Road #100, Indianapolis, IN 46260 USA
| | - Jacqueline F Schultz
- 1Trauma Department, St. Vincent Indianapolis Hospital, 8240 Naab Road #100, Indianapolis, IN 46260 USA
| | - Alexander J Kinstedt
- 1Trauma Department, St. Vincent Indianapolis Hospital, 8240 Naab Road #100, Indianapolis, IN 46260 USA
| | - Jonathan M Saxe
- 1Trauma Department, St. Vincent Indianapolis Hospital, 8240 Naab Road #100, Indianapolis, IN 46260 USA
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Byrne R, Parks A, Hazelton JP, Kirchhoff M, Roberts BW. Incidence and significance of injuries on secondary CT imaging after initial selective imaging in blunt trauma patients. Am J Emerg Med 2019; 38:1588-1593. [PMID: 31699428 DOI: 10.1016/j.ajem.2019.158432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE It is unclear if additional computerized tomography (CT) imaging is warranted after injuries are identified on CT in blunt trauma patients. The objective of this study was to determine the incidence and significance of injuries identified on secondary CT imaging after identification of injuries on initial CTs in blunt trauma patients. METHODS This was a retrospective cohort study at an academic Level 1 trauma center with a two-tiered trauma system. INCLUSION CRITERIA age ≥ 18, level 2 trauma activation, injury identified on initial CT, and secondary CTs ordered. Secondary injuries were categorized as resulting in: no changes, minor changes, or major changes in management. RESULTS 537 patients underwent 1179 initial CT scans which identified 744 injuries. There were 1094 secondary CTs which identified 143 additional injuries in 94 (18%) patients. 9 (1.7%) patients had at least one major management change and 64 (12%) had at least one minor management change. Rib fracture(s) was the most common injury on secondary scans [45/143 (32%)]. The major management changes were: tube thoracostomy for pneumothorax (4 patients), blood transfusion for hemoperitoneum (1 patient), surgery for acetabular fracture (1 patient), thoracolumbar brace for spine fracture (2 patients) and angiography for splenic injury (1 patient). CONCLUSION While a significant proportion of patients (18%) had injuries on secondary CT, only 1.7% of patients had a resultant major management change. Future research is warranted to determine the need for additional CT imaging after an initial selective imaging strategy in blunt trauma patients.
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Affiliation(s)
- Richard Byrne
- Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, Department of Emergency Medicine, United States of America.
| | - Aimee Parks
- Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, Department of Emergency Medicine, United States of America
| | - Joshua P Hazelton
- Penn State Hershey Medical Center, Penn State College of Medicine, Hershey, PA, Division of Trauma, Critical Care and Acute Care Surgery, United States of America
| | - Michael Kirchhoff
- Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, Department of Emergency Medicine, United States of America
| | - Brian W Roberts
- Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, Department of Emergency Medicine, United States of America
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Hinzpeter R, Sprengel K, Wanner GA, Mildenberger P, Alkadhi H. Repeated CT scans in trauma transfers: An analysis of indications, radiation dose exposure, and costs. Eur J Radiol 2017; 88:135-140. [DOI: 10.1016/j.ejrad.2017.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 01/01/2017] [Accepted: 01/05/2017] [Indexed: 11/29/2022]
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Hinzpeter R, Boehm T, Boll D, Constantin C, Del Grande F, Fretz V, Leschka S, Ohletz T, Brönnimann M, Schmidt S, Treumann T, Poletti PA, Alkadhi H. Imaging algorithms and CT protocols in trauma patients: survey of Swiss emergency centers. Eur Radiol 2016; 27:1922-1928. [DOI: 10.1007/s00330-016-4574-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/11/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
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Kelleher MS, Gao G, Rolen MF, Bokhari SJ. Completion CT of Chest, Abdomen, and Pelvis after Acute Head and Cervical Spine Trauma: Incidence of Acute Traumatic Findings in the Setting of Low-Velocity Trauma. Radiology 2016; 279:395-9. [DOI: 10.1148/radiol.2015151509] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hemmes B, Jeukens CRLPN, Kemerink GJ, Brink PRG, Poeze M. Effect of spinal immobilisation devices on radiation exposure in conventional radiography and computed tomography. Emerg Radiol 2016; 23:147-53. [PMID: 26754428 PMCID: PMC4805719 DOI: 10.1007/s10140-015-1371-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 12/09/2015] [Indexed: 02/04/2023]
Abstract
Trauma patients at risk for, or suspected of, spinal injury are frequently transported to hospital using full spinal immobilisation. At the emergency department, immobilisation is often maintained until radiological work-up is completed. In this study, we examined how these devices influence radiation exposure and noise, as a proxy for objective image quality. Conventional radiographs (CR) and computer tomography (CT) scans were made using a phantom immobilised on two types of spineboard and a vacuum mattress and using two types of headblocks. Images were compared for radiation transmission and quantitative image noise. In CR, up to 23 % and, in CT, up to 11 % of radiation were blocked by the devices. Without compensation for the decreased transmission, noise increased by up to 16 % in CT, depending on the device used. Removing the headblocks led to a statistically significant improvement in transmission with automatic exposure control (AEC) enabled. Physicians should make an informed decision whether the increased radiation exposure outweighs the risk of missing a clinically significant injury by not making a CR or CT scan. Manufacturers of immobilisation devices should take radiological properties of their devices into account in the development and production process.
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Affiliation(s)
- Baukje Hemmes
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Cécile R L P N Jeukens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gerrit J Kemerink
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter R G Brink
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martijn Poeze
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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Moore CL, Broder J, Gunn ML, Bhargavan-Chatfield M, Cody D, Cullison K, Daniels B, Gans B, Kennedy Hall M, Gaines BA, Goldman S, Heil J, Liu R, Marin JR, Melnick ER, Novelline RA, Pare J, Repplinger MD, Taylor RA, Sodickson AD. Comparative Effectiveness Research: Alternatives to "Traditional" Computed Tomography Use in the Acute Care Setting. Acad Emerg Med 2015; 22:1465-73. [PMID: 26576033 DOI: 10.1111/acem.12831] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/12/2015] [Indexed: 01/07/2023]
Abstract
Computed tomography (CT) scanning is an essential diagnostic tool and has revolutionized care of patients in the acute care setting. However, there is widespread agreement that overutilization of CT, where benefits do not exceed possible costs or harms, is occurring. The goal was to seek consensus in identifying and prioritizing research questions and themes that involve the comparative effectiveness of "traditional" CT use versus alternative diagnostic strategies in the acute care setting. A modified Delphi technique was used that included input from emergency physicians, emergency radiologists, medical physicists, and an industry expert to achieve this.
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Affiliation(s)
- Christopher L. Moore
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Joshua Broder
- Department of Surgery; Section of Emergency Medicine; Duke University; Durham NC
| | - Martin L. Gunn
- Department of Radiology; University of Washington; Seattle WA
| | | | - Dianna Cody
- Department of Imaging Physics; University of Texas Houston; Houston TX
| | - Kevin Cullison
- Department of Emergency Medicine; Washington University; St. Louis MO
| | - Brock Daniels
- Department of Emergency Medicine; University of California Davis; Davis CA
| | - Bradley Gans
- Department of Radiology; Ohio State University; Cleveland WA
| | - M. Kennedy Hall
- Department of Emergency Medicine; University of Washington; Seattle WA
| | - Barbara A. Gaines
- Division of Pediatric General and Thoracic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Sarah Goldman
- Department of Emergency Medicine; Jacobi Medical Center; New York NY
| | - John Heil
- medint Holdings; LLC d.b.a Imalogix; King of Prussia PA
| | - Rachel Liu
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Jennifer R. Marin
- Departments of Pediatrics and Emergency Medicine; University of Pittsburgh School of Medicine; Pittsburgh PA
- Department of Pediatrics; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Edward R. Melnick
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | | | - Joseph Pare
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Michael D. Repplinger
- Departments of Emergency Medicine and Radiology; University of Wisconsin School of Medicine and Public Health; Madison WI
| | - Richard A. Taylor
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
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Carnevale TJ, Meng D, Wang JJ, Littlewood M. Impact of an Emergency Medicine Decision Support and Risk Education System on Computed Tomography and Magnetic Resonance Imaging Use. J Emerg Med 2015; 48:53-7. [DOI: 10.1016/j.jemermed.2014.07.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 05/29/2014] [Accepted: 07/01/2014] [Indexed: 11/29/2022]
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13
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Gordic S, Alkadhi H, Simmen HP, Wanner G, Cadosch D. Characterization of indeterminate spleen lesions in primary CT after blunt abdominal trauma: potential role of MR imaging. Emerg Radiol 2014; 21:491-8. [PMID: 24788055 DOI: 10.1007/s10140-014-1227-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/14/2014] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to determine the value of magnetic resonance imaging (MRI) for characterization of indeterminate spleen lesions in primary computed tomography (CT) of patients with blunt abdominal trauma. Twenty-five consecutive patients (8 female, 17 male, mean age 51.6 ± 22.4 years) with an indeterminate spleen lesion diagnosed at CT after blunt abdominal trauma underwent MRI with T2- and T1-weighted images pre- and post-contrast material administration. MRI studies were reviewed by two radiologists. Age, gender, injury mechanism, injury severity score (ISS), management of patients, time interval between CT and MRI, and length of hospital stay were included into the analysis. Patient history, clinical history, imaging, and 2-month clinical outcome including review of medical records and telephone interviews served as reference standard. From the 25 indeterminate spleen lesions in CT, 11 (44 %) were traumatic; nine (36 %) were non-traumatic (pseudocysts, n=5; hemangioma, n=4) and five proven to represent artifacts in CT. The ISS (P<0.001) and the length of hospital stay (P=0.03) were significantly higher in patients with spleen lesions as compared with those without. All other parameters were similar among groups (all, P>0.05). The MRI features ill-defined lesion borders, variable signal intensity on T1- and T2-weighted images depending on the age of the hematoma, focal contrast enhancement indicating traumatic pseudoaneurysm, perilesional contrast enhancement, and edema were most indicative for traumatic spleen lesions. As compared with CT (2/25), MRI (5/25) better depicted thin subcapsular hematomas as indicator of traumatic spleen injury. In conclusion, MRI shows value for characterizing indeterminate spleen lesions in primary CT after blunt abdominal trauma.
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Affiliation(s)
- Sonja Gordic
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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