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Odeh Couvertier V, Patterson BW, Zayas‐Cabán G. Association between advanced image ordered in the emergency department on subsequent imaging for abdominal pain patients. Acad Emerg Med 2022; 29:1078-1083. [PMID: 35639008 PMCID: PMC9502755 DOI: 10.1111/acem.14541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Abdominal pain is associated with high rates of emergency department (ED) imaging utilization and revisits. While imaging often improves diagnosis, a better understanding is needed on when the decision to image is justified and how it influences subsequent resource utilization and outcomes for patients in the ED presenting with abdominal pain. We evaluated the association between advanced ED imaging on subsequent outpatient imaging and on revisits among abdominal pain patients discharged from the ED. METHODS A retrospective, observational study was conducted using electronic health record data from an academic ED in the U.S. Midwest. A sample of Medicare patients with a chief complaint of abdominal pain from January 2013 to December 2016 following ED evaluation were included in the analysis. Logistic regression was used to estimate associations between receiving advanced imaging in the ED and subsequent outpatient imaging within 7-, 14-, and 28-day windows after discharge, and 30-day revisit rates to the study ED and to any ED. RESULTS Of the 1385 ED visits with abdominal pain chief complaint and discharged home from the ED, individuals who were not imaged in the ED had significantly higher adjusted odds of being imaged outside the ED within 7 days (adjusted odds ratio [aOR] 6.65, 95% confidence interval [CI] 3.96-11.17, p < 0.001), 14 days (aOR 4.69, 95% CI 3.11-7.07, p < 0.001), and 28 days (aOR 3.1, 95% CI 2.25-4.27, p < 0.001) of being discharged and had a significantly higher adjusted odds of revisiting the study ED (aOR 1.65, 95% CI 1.29-2.12, p < 0.001) and revisiting any ED (aOR 1.47, 95% CI 1.16-1.86, p = 0.001) within 30 days of being discharged. CONCLUSIONS Abdominal imaging in the ED was associated with significantly lower imaging utilization after discharge and 30-day revisit rates, suggesting that imaging in the ED may replace downstream outpatient imaging.
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Affiliation(s)
- Valerie Odeh Couvertier
- Department of Industrial and Systems EngineeringUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Brian W. Patterson
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Gabriel Zayas‐Cabán
- Department of Industrial and Systems EngineeringUniversity of Wisconsin–MadisonMadisonWisconsinUSA
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin–MadisonMadisonWisconsinUSA
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2
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Broder JS, Oliveira J E Silva L, Bellolio F, Freiermuth CE, Griffey RT, Hooker E, Jang TB, Meltzer AC, Mills AM, Pepper JD, Prakken SD, Repplinger MD, Upadhye S, Carpenter CR. Guidelines for Reasonable and Appropriate Care in the Emergency Department 2 (GRACE-2): Low-risk, recurrent abdominal pain in the emergency department. Acad Emerg Med 2022; 29:526-560. [PMID: 35543712 DOI: 10.1111/acem.14495] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 02/07/2023]
Abstract
This second Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE-2) from the Society for Academic Emergency Medicine is on the topic "low-risk, recurrent abdominal pain in the emergency department." The multidisciplinary guideline panel applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding four priority questions for adult emergency department patients with low-risk, recurrent, undifferentiated abdominal pain. The intended population includes adults with multiple similar presentations of abdominal signs and symptoms recurring over a period of months or years. The panel reached the following recommendations: (1) if a prior negative computed tomography of the abdomen and pelvis (CTAP) has been performed within 12 months, there is insufficient evidence to accurately identify populations in whom repeat CTAP imaging can be safely avoided or routinely recommended; (2) if CTAP with IV contrast is negative, we suggest against ultrasound unless there is concern for pelvic or biliary pathology; (3) we suggest that screening for depression and/or anxiety may be performed during the ED evaluation; and (4) we suggest an opioid-minimizing strategy for pain control. EXECUTIVE SUMMARY: The GRACE-2 writing group developed clinically relevant questions to address the care of adult patients with low-risk, recurrent, previously undifferentiated abdominal pain in the emergency department (ED). Four patient-intervention-comparison-outcome-time (PICOT) questions were developed by consensus of the writing group, who performed a systematic review of the literature and then synthesized direct and indirect evidence to formulate recommendations, following GRADE methodology. The writing group found that despite the commonality and relevance of these questions in emergency care, the quantity and quality of evidence were very limited, and even fundamental definitions of the population and outcomes of interest are lacking. Future research opportunities include developing precise and clinically relevant definitions of low-risk, recurrent, undifferentiated abdominal pain and determining the scope of the existing populations in terms of annual national ED visits for this complaint, costs of care, and patient and provider preferences.
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Affiliation(s)
- Joshua S Broder
- Department of Surgery, Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline E Freiermuth
- Department of Emergency Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Richard T Griffey
- Department of Emergency Medicine and Emergency Care Research Core, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Edmond Hooker
- Department of Health Services Administration, Xavier University, Cincinnati, Ohio, USA
| | - Timothy B Jang
- Department of Emergency Medicine, University of California Los Angeles, UCLA Santa Monica Medical Center, Torrance, California, USA
| | - Andrew C Meltzer
- Department of Emergency Medicine, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Angela M Mills
- Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.,Society for Academic Emergency Medicine, Des Plaines, Illinois, USA
| | | | | | - Michael D Repplinger
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Christopher R Carpenter
- Department of Emergency Medicine and Emergency Care Research Core, Washington University School of Medicine, St. Louis, Missouri, USA.,Society for Academic Emergency Medicine, Des Plaines, Illinois, USA
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3
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Coleman B, Ramakrishnan K. Surgical Problems of the Digestive System. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Leenellett E, Rieves A. Occult Abdominal Trauma. Emerg Med Clin North Am 2021; 39:795-806. [PMID: 34600638 DOI: 10.1016/j.emc.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Occult abdominal injuries are common and can be associated with increased risk of morbidity and mortality. Patients with a delayed presentation to care or who are multiply injured are at increased risk of this type of injury, and a high index of suspicion must be maintained. A careful combination of history, physical examination, laboratory, and imaging can be quite helpful in mitigating the risk of a missed occult abdominal injury.
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Affiliation(s)
- Elizabeth Leenellett
- Department of Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way, Room 1505, Cincinnati, OH 45267-0769, USA.
| | - Adam Rieves
- Department of Emergency Medicine, Washington University in Saint Louis, 660 South Euclid Avenue, BC 8072, Saint Louis, MO 63110, USA
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5
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Wu W, Zhao T, Li Y, Guo X, He W, Yang Y. Preliminary study of the characteristics of rib fractures and their impact on pulmonary ventilatory function. J Cardiothorac Surg 2021; 16:155. [PMID: 34059106 PMCID: PMC8165336 DOI: 10.1186/s13019-021-01538-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to investigate the pulmonary ventilation function (PVF) according to different types of rib fractures and pain levels. Methods This was a retrospective study of patients with thoracic trauma admitted to our ward from May 1, 2015, to February 1, 2017. Vital capacity (VC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF) were measured on admission. A numerical rating scale (NRS) was used for pain assessment. Results A total of 118 (85 males and 33 females) were included. The location of rib fractures did not affect the PVF. When the number of rib fractures was ≥5, the PVF was lower than in those with ≤4 fractures (VC: 0.40 vs. 0.47, P = 0.009; FEV1: 0.37 vs. 0.44, P = 0.012; PEF: 0.17 vs. 0.20, P = 0.031). There were no difference in PVF values between rib fractures with multiple locations and those with non-multiple locations (VC: 0.41 vs. 0.43, P = 0.202; FEV1: 0.37 vs. 0.39, P = 0.692; PEF: 0.18 vs. 0.18, P = 0.684). When there were ≥ 5 breakpoints, the PVF parameters were lower than those with ≤4 breakpoints (VC: 0.40 vs. 0.50, P = 0.030; FEV1: 0.37 vs. 0.45, P = 0.022; PEF: 0.18 vs. 0.20, P = 0.013). When the NRS ≥ 7, the PVF values were lower than for those with NRS ≤ 6 (VC: 0.41 vs. 0.50, P = 0.003; FEV1: 0.37 vs. 0.47, P = 0.040; PEF: 0.18 vs. 0.20, P = 0.027). Conclusions When the total number of fractured ribs is ≥5, there are ≥5 breakpoints, or NRS is ≥7, the VC, FEV1, and PEF are more affected. Trial registration The trial was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, and individual consent for this retrospectively registered analysis was waived.
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Affiliation(s)
- Weiming Wu
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China.
| | - Tiancheng Zhao
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China
| | - Yang Li
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China
| | - Xiang Guo
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China
| | - Weiwei He
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China
| | - Yi Yang
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China.
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Bashir K, Azad AM, Hereiz A, Bashir MT, Masood M, Elmoheen A. Current Use, Perceived Barriers, and Learning Preference of Point of Care Ultrasound (POCUS) in the Emergency Medicine in Qatar - A Mixed Design. Open Access Emerg Med 2021; 13:177-182. [PMID: 34040459 PMCID: PMC8140913 DOI: 10.2147/oaem.s304153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Point of care ultrasound (POCUS) has been a part of emergency medicine (EM) training for almost two decades. EM training program has a very broad and rigorous POCUS curricula which, in several cases, does not translate to routine application in clinical settings. This study therefore sought to compare the indications, utilization, barriers, and preferred POCUS educational method in a large Middle Eastern academic EM. Methodology A validated questionnaire was emailed to 50 EM faculties between April and May 2019. Volunteer faculty members partook in a semi-structured interview to better understand the indications, current use, barriers, and preferred learning method. Responses were anonymous, and data were analyzed with descriptive statistics. Results This was a mixed design study. 30/50 (60%) of faculty responded to the survey, with a mean age of 39.2 years and a mean number of years in practice, 13.1. 55% (n=28) completed POCUS training in less than five years, while 45% completed more than five years ago and 5% never completed it. Forty percent of EM physicians were trained in Africa, while 55% were qualified in Asia and 5% completed their training in Europe. The indications and frequently performed procedures were consistent with the previous research. The common barrier reported was lack of time, lack of credentialing, lack of quality assurance, and national guidelines. The majority of the faculty preferred a blended learning approach for POCUS. Conclusion POCUS perceived barriers to its full use include time constraints, lack of national guidelines, and credentialing (awarding POCUS qualifications) of the faculty. Blended learning appears to be the preferred approach towards acquiring the knowledge and skills of POCUS.
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Affiliation(s)
- Khalid Bashir
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar
| | | | - Ayman Hereiz
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar
| | | | - Maarij Masood
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar
| | - Amr Elmoheen
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar
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Linakis SW, Lloyd JK, Kline D, Holmes JF, Stanley RM, Leonard JC. Field triage of children with abdominal trauma. TRAUMA-ENGLAND 2021. [DOI: 10.1177/1460408620933524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Identify physical findings in children with abdominal trauma to inform prehospital providers regarding appropriate hospital destinations. Methods This is a secondary analysis of the Pediatric Emergency Care Applied Research Network Abdominal Trauma Public Use Dataset. Children involved in motor vehicle collisions; struck by motor vehicles at >20 mph; involved in all-terrain vehicle, motorcycle, or scooter accidents; or who fell from >10 ft ( n = 5575) were included. Stepwise multivariable multinomial logistic regression was used to compare clinical findings at presentation between children with no intra-abdominal injury, intra-abdominal injury without intervention, and intra-abdominal injury with intervention (laparoscopy/laparotomy, embolization, red blood cell transfusion, or admission >48 h on intravenous fluids). Results Compared to children with no intra-abdominal injury, children with intra-abdominal injury (with and without intervention) were more likely to have evidence of abdominal wall trauma, abdominal tenderness, peritoneal irritation, decreased breath sounds, distracting painful injury, and evidence of thoracic trauma. Children with intra-abdominal injury requiring intervention were more likely to have evidence of abdominal wall trauma (OR 3.32, 95% CI 2.03–5.44) and be intubated (OR 4.93, 95% CI 3.17–7.65) when compared to children with intra-abdominal injury without intervention. Conclusions The findings of abdominal tenderness, peritoneal irritation, decreased breath sounds, distracting painful injury, and thoracic trauma may be used to identify children who warrant evaluation at any trauma center because of increased risk of intra-abdominal injury, whereas intubation and evidence of abdominal wall trauma help identify children with intra-abdominal injury in need of transport to a pediatric trauma center due to risk of undergoing intervention.
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Affiliation(s)
- Seth W Linakis
- Division of Pediatric Emergency Medicine, Nationwide Children's Hospital and The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julia K Lloyd
- Division of Pediatric Emergency Medicine, Nationwide Children's Hospital and The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David Kline
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - James F Holmes
- Department of Emergency Medicine, UC Davis Health, Sacramento, CA, USA
| | - Rachel M Stanley
- Division of Pediatric Emergency Medicine, Nationwide Children's Hospital and The Ohio State University Wexner Medical Center, Columbus, OH, USA
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Julie C Leonard
- Division of Pediatric Emergency Medicine, Nationwide Children's Hospital and The Ohio State University Wexner Medical Center, Columbus, OH, USA
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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8
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Wirth S, Hebebrand J, Basilico R, Berger FH, Blanco A, Calli C, Dumba M, Linsenmaier U, Mück F, Nieboer KH, Scaglione M, Weber MA, Dick E. European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version). Insights Imaging 2020; 11:135. [PMID: 33301105 PMCID: PMC7726597 DOI: 10.1186/s13244-020-00947-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although some national recommendations for the role of radiology in a polytrauma service exist, there are no European guidelines to date. Additionally, for many interdisciplinary guidelines, radiology tends to be under-represented. These factors motivated the European Society of Emergency Radiology (ESER) to develop radiologically-centred polytrauma guidelines. RESULTS Evidence-based decisions were made on 68 individual aspects of polytrauma imaging at two ESER consensus conferences. For severely injured patients, whole-body CT (WBCT) has been shown to significantly reduce mortality when compared to targeted, selective CT. However, this advantage must be balanced against the radiation risk of performing more WBCTs, especially in less severely injured patients. For this reason, we recommend a second lower dose WBCT protocol as an alternative in certain clinical scenarios. The ESER Guideline on Radiological Polytrauma Imaging and Service is published in two versions: a full version (download from the ESER homepage, https://www.eser-society.org ) and a short version also covering all recommendations (this article). CONCLUSIONS Once a patient has been accurately classified as polytrauma, each institution should be able to choose from at least two WBCT protocols. One protocol should be optimised regarding time and precision, and is already used by most institutions (variant A). The second protocol should be dose reduced and used for clinically stable and oriented patients who nonetheless require a CT because the history suggests possible serious injury (variant B). Reading, interpretation and communication of the report should be structured clinically following the ABCDE format, i.e. diagnose first what kills first.
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Affiliation(s)
- Stefan Wirth
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria.
- Department of Radiology, LMU University Hospital, Munich, Germany.
- Department of Radiology and Nuclear Medicine, Schwarzwald-Baar-Hospital, Villingen-Schwenningen, Germany.
| | - Julian Hebebrand
- Department of Radiology, LMU University Hospital, Munich, Germany
| | - Raffaella Basilico
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Neurosciences, Imaging and Clinical Science, University of Chieti, Chieti, Italy
| | - Ferco H Berger
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ana Blanco
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Radiology, University Hospital JM Morales Meseguer, Murcia, Spain
| | - Cem Calli
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Radiology, Ege University Medical Faculty, Izmir, Turkey
| | - Maureen Dumba
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Imperial College NHS Trust, St Mary's Campus, London, UK
| | - Ulrich Linsenmaier
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Diagnostic and Interventional Radiology, Helios Clinic Munich West, Munich, Germany
| | - Fabian Mück
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Diagnostic and Interventional Radiology, Helios Clinic Munich West, Munich, Germany
| | - Konraad H Nieboer
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Radiology, University Ziekenhuis, Vrije University (VUB), Brussels, Belgium
| | - Mariano Scaglione
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- James Cook University Hospital, Teesside University, Middlesbrough, UK
- Department of Imaging, Pineta Grande Hospital, Castel Volturno, Italy
| | - Marc-André Weber
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Elizabeth Dick
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Imperial College NHS Trust, St Mary's Campus, London, UK
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Surgical Problems of the Digestive System. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_100-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Reynolds-Vaughn V, Riddle J, Brown J, Schiesel M, Wayant C, Vassar M. Evaluation of Spin in the Abstracts of Emergency Medicine Randomized Controlled Trials. Ann Emerg Med 2019; 75:423-431. [PMID: 31101371 DOI: 10.1016/j.annemergmed.2019.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/18/2019] [Accepted: 03/11/2019] [Indexed: 01/21/2023]
Abstract
STUDY OBJECTIVE We aim to investigate spin in emergency medicine abstracts, using a sample of randomized controlled trials from high-impact-factor journals with statistically nonsignificant primary endpoints. METHODS This study investigated spin in abstracts of emergency medicine randomized controlled trials from emergency medicine literature, with studies from 2013 to 2017 from the top 5 emergency medicine journals and general medical journals. Investigators screened records for inclusion and extracted data for spin. We considered evidence of spin if trial authors focused on statistically significant results, interpreted statistically nonsignificant results as equivalent or noninferior, used favorable rhetoric in the interpretation of nonsignificant results, or claimed benefit of an intervention despite statistically nonsignificant results. RESULTS Of 772 abstracts screened, 114 randomized controlled trials reported statistically nonsignificant primary endpoints. Spin was found in 50 of 114 abstracts (44.3%). Industry-funded trials were more likely to have evidence of spin in the abstract (unadjusted odds ratio 3.4; 95% confidence interval 1.1 to 11.9). In the abstracts' results, evidence of spin was most often due to authors' emphasizing a statistically significant subgroup analysis (n=9). In the abstracts' conclusions, spin was most often due to authors' claiming they accomplished an objective that was not a prespecified endpoint (n=14). CONCLUSION Spin was prevalent in the selected randomized controlled trial, emergency medicine abstracts. Authors most commonly incorporated spin into their reports by focusing on statistically significant results for secondary outcomes or subgroup analyses when the primary outcome was statistically nonsignificant. Spin was more common in studies that had some component of industry funding.
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Affiliation(s)
| | - Jonathan Riddle
- Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Jamin Brown
- Department of Emergency Medicine, Oklahoma State University Medical Center, Tulsa, OK
| | - Michael Schiesel
- Department of Emergency Medicine, Oklahoma State University Medical Center, Tulsa, OK
| | - Cole Wayant
- Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, OK
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Aubrion A, Creusier L, Zarforoushan G. Une fracture splénique secondaire au massage cardiaque externe sur un terrain d’hypertension portale. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2018-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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The Results of Randomized Controlled Trials in Emergency Medicine Are Frequently Fragile. Ann Emerg Med 2018; 73:565-576. [PMID: 30551894 DOI: 10.1016/j.annemergmed.2018.10.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 10/09/2018] [Accepted: 10/29/2018] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE Randomized controlled trials govern evidence-based clinical practice, and it is therefore critical that their results be robust. We aim to investigate the fragility of randomized controlled trials in emergency medicine by determining how often significance would be nullified with small changes in outcomes using the fragility index. METHODS We conducted a methodological systematic review of randomized controlled trials in emergency medicine published in the top 10 general medicine journals and the top 10 emergency medicine journals. Inclusion criteria required that trials be emergency medicine studies structured with a 2-arm or 2-by-2 factorial design and report at least 1 statistically significant dichotomous outcome. RESULTS A total of 180 trials met inclusion criteria. The median fragility index across all trials in emergency medicine was 4 (interquartile range [IQR] 2 to 10) and the median sample size was 140 (IQR 69.5 to 286). For trials from general medicine journals (n=32), the median fragility index was 9 (IQR 4 to 16.5) and the median sample size was 415.5 (IQR 219.5 to 901); for trials from emergency medicine journals (n=148), the median fragility index was 4 (IQR 1 to 9) and the median sample size was 119 (IQR 60 to 227.25). One third of all trials (62/180) had a loss to follow-up that was greater than or equal to the fragility index. There was a modest correlation between fragility index and total number of events (r=0.36; 95% confidence interval [CI] 0.23 to 0.48) and a weak correlation between fragility index and total sample size (r=0.26; 95% CI 0.12 to 0.39). There was no correlation between fragility index and either P value (r=-0.14; 95% CI -0.28 to -0.006) or Science Citation Index (r=0.07; 95% CI -0.08 to 0.22). CONCLUSION The statistical significance of the results of randomized controlled trials in emergency medicine was often contingent on a small number of events. Until frequentist interpretation of clinical trials is replaced with Bayesian analysis, the fragility index may have utility as a tool to aid clinicians in assessing the robustness of randomized controlled trials in emergency medicine when considered in conjunction with the fragility quotient and other reported metrics.
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Rodriguez RM, Hawthorne N, Murphy SP, Theus M, Haase D, Chuku C, Wen J. Blunt Trauma Abdominal and Pelvic Computed Tomography Has Low Yield for Injuries in More Than One Anatomic Region. West J Emerg Med 2018; 19:768-773. [PMID: 30202486 PMCID: PMC6123097 DOI: 10.5811/westjem.2018.6.37646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/20/2018] [Accepted: 06/07/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction Most trauma centers order abdominal and pelvic computed tomography (CT) as an automatically paired CT for adult blunt trauma evaluation. However, excessive CT utilization adds risks of excessive exposure to ionizing radiation, the need to work up incidental findings (leading to unnecessary and invasive tests), and greater costs. Examining a cohort of adult blunt trauma patients that received paired abdominal and pelvic (A/P) CT, we sought to determine the diagnostic yield of clinically significant injuries (CSI) in the following: 1) the abdomen alone; 2) the pelvis alone; 3) the lumbosacral spine alone; and 4) more than one of these anatomic regions concomitantly. Methods In this retrospective study, we reviewed the imaging and hospital course of a consecutive sample of blunt trauma activation patients older than 14 years of age who received paired A/P CT during their blunt trauma assessments at an urban Level I trauma center from April through October 2014. Categorization of CSI was determined according to an a priori, expert panel-derived classification scheme. Results The median age of the 689 patients who had A/P CT was 48 years old; 68.1% were male; 64.0% were admitted, and hospital mortality was 3.6%. CSI yields were as follows: abdomen 2.2% (95% confidence interval [CI] [1.3–3.6%]); pelvis 2.9% (95% CI [1.9–4.4%]); lumbosacral spine 0.6% (95% CI [0.2–1.5%]); both abdomen and pelvis 0.3% (95% CI [0.1–1.1%]); both the abdomen and lumbosacral spine 0.6% (0.2–1.5%); both the pelvis and lumbosacral spine 0.1% (0.0–0.8%); all three regions – abdomen, pelvis and lumbosacral spine – 0.1% (0.0–0.8%). Conclusion Automatic pairing of A/P CT has very low diagnostic yield for CSI in both the abdomen and pelvis. These data suggest a role for selective CT imaging protocols that image these regions individually instead of automatically as a pair.
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Affiliation(s)
- Robert M Rodriguez
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Noah Hawthorne
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Shelby P Murphy
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Marcus Theus
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - David Haase
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Chika Chuku
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Jason Wen
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
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14
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Abstract
To stabilize critically ill patients, emergency and critical care medicine providers often require rapid diagnosis and intervention. The demand for a safe, timely diagnostic device, alongside technological innovation, led to the advent of point-of-care ultrasonography (POCUS). POCUS allows the provider to gain invaluable clinical information with a high level of accuracy, leading to better clinical decision-making and improvements in patient safety. We have outlined the history of POCUS adaptation in emergency and critical care medicine and various clinical applications of POCUS described in literature.
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15
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Heydari F, Ashrafi A, Kolahdouzan M. Diagnostic Accuracy of Focused Assessment with Sonography for Blunt Abdominal Trauma in Pediatric Patients Performed by Emergency Medicine Residents versus Radiology Residents. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2018; 2:e31. [PMID: 31172094 PMCID: PMC6549207 DOI: 10.22114/ajem.v0i0.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Focused assessment with sonography for trauma (FAST) has been shown to be useful to detect intraperitoneal free fluid in patients with blunt abdominal trauma (BAT). OBJECTIVE We compared the diagnostic accuracy of FAST performed by emergency medicine residents (EMRs) and radiology residents (RRs) in pediatric patients with BAT. METHOD In this prospective study, pediatric patients with BAT and high energy trauma who were referred to the emergency department (ED) at Al-Zahra and Kashani hospitals in Isfahan, Iran, were evaluated using FAST, first by EMRs and subsequently by RRs. The reports provided by the two resident groups were compared with the final outcome based on the results of the abdominal computed tomography (CT), operative exploration, and clinical observation. RESULTS A total of 101 patients with a median age of 6.75 ± 3.2 years were enrolled in the study between January 2013 and May 2014. These patients were evaluated using FAST, first by EMRs and subsequently by RRs. A good diagnostic agreement was noted between the results of the FAST scans performed by EMRs and RRs (κ = 0.865, P < 0.001). The sensitivity, specificity, positive and negative predictive values, and accuracy in evaluating the intraperitoneal free fluid were 72.2%, 85.5%, 52%, 93.3%, and 83.2%, respectively, when FAST was performed by EMRs and 72.2%, 86.7%, 54.2%, 93.5%, and 84.2%, respectively, when FAST was performed by RRs. No significant differences were seen between the EMR- and RR-performed FAST. CONCLUSION In this study, FAST performed by EMRs had acceptable diagnostic value, similar to that performed by RRs, in patients with BAT.
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Affiliation(s)
- Farhad Heydari
- Emergency Medicine Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ayoub Ashrafi
- Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Kolahdouzan
- Department of Thoracic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
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16
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Morchel H, Ogedegbe C, Chaplin W, Cheney B, Zakharchenko S, Misch D, Schwartz M, Feldman J, Kaul S. Evaluation of a Novel Wireless Transmission System for Trauma Ultrasound Examinations From Moving Ambulances. Mil Med 2018; 183:111-118. [PMID: 29635573 DOI: 10.1093/milmed/usx167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 12/23/2017] [Indexed: 11/12/2022] Open
Abstract
Objective To determine if physicians trained in ultrasound interpretation perceive a difference in image quality and usefulness between Extended Focused Assessment with Sonography ultrasound examinations performed at bedside in a hospital vs. by emergency medical technicians minimally trained in medical ultrasound on a moving ambulance and transmitted to the hospital via a novel wireless system. In particular, we sought to demonstrate that useful images could be obtained from patients in less than optimal imaging conditions; that is, while they were in transport. Methods Emergency medical technicians performed the examinations during transport of blunt trauma patients. Upon patient arrival at the hospital, a bedside Extended Focused Assessment with Sonography examination was performed by a physician. Both examinations were recorded and later reviewed by physicians trained in ultrasound interpretation. Results Data were collected on 20 blunt trauma patients over a period of 13 mo. Twenty ultrasound-trained physicians blindly compared transmitted vs. bedside images using 11 Questionnaire for User Interaction Satisfaction scales. Four paired samples t-tests were conducted to assess mean differences between ratings for ambulatory and base images. Conclusion Although there is a slight tendency for the average rating across all subjects and raters to be slightly higher in the base than in the ambulatory condition, none of these differences are statistically significant. These results suggest that the quality of the ambulatory images was viewed as essentially as good as the quality of the base images.
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Affiliation(s)
- Herman Morchel
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - Chinwe Ogedegbe
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - William Chaplin
- Department of Psychology, St. John's University, 8000 Utopia Parkway, Jamaica, NY 11439
| | - Brianna Cheney
- Department of Psychology, St. John's University, 8000 Utopia Parkway, Jamaica, NY 11439
| | - Svetlana Zakharchenko
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - David Misch
- School of Medicine, St. George's University, University Centre, Grenada, West Indies
| | - Matthew Schwartz
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - Joseph Feldman
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - Sanjeev Kaul
- Trauma and Injury Prevention, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
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17
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Steinemann S, Fernandez M. Variation in training and use of the focused assessment with sonography in trauma (FAST). Am J Surg 2017; 215:255-258. [PMID: 29174769 DOI: 10.1016/j.amjsurg.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/06/2017] [Accepted: 11/04/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Training in ultrasound is variable among residents and practicing traumatologists. Focused Assessment with Sonography in Trauma (FAST) may be underused in non-urbanized areas, possibly due to lack of training. METHODS State trauma registry data from January 2014-June 2016 were reviewed for FAST results. Trauma practitioners were surveyed querying training, confidence, and obstacles to performing FAST. RESULTS 12,855 records revealed highest FAST use at the urban Level II center (39%, p < 0.0001). Despite similar injury patterns, non-urban/Level III centers' frequency of FAST was only 1-28%. 39 practitioners were surveyed, those with training (54%) were more likely to use FAST (p < 0.05). 61% of practitioners outside the Level II center cited lack of confidence in their ability to perform FAST as the primary reason for omitting the exam. CONCLUSIONS FAST is relatively underused in non-urbanized areas of the state. Lack of confidence in ability to perform FAST was cited as the primary barrier.
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Affiliation(s)
- Susan Steinemann
- University of Hawaii, Department of Surgery, Honolulu, HI, USA; The Queen's Medical Center, Honolulu, HI, USA.
| | - Mayumi Fernandez
- University of Hawaii, Department of Surgery, Honolulu, HI, USA; The Queen's Medical Center, Honolulu, HI, USA.
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18
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Jejunal Perforation Following Blunt Abdominal Trauma; a Case Report. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2017; 1:e9. [PMID: 31172061 PMCID: PMC6548091 DOI: 10.22114/ajem.v1i1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: The possibility of intestinal injury for all patients presenting to emergency department (ED) with blunt abdominal trauma, despite minimal physical signs should be considered. To highlight the patient management, hear, we report a case of hollow viscus injuries resulting from blunt abdominal trauma referring to a teaching hospital in Tehran, Iran. Case presentation: A 30-year-old man presented to the ED after “falling into a hole” with his back and had direct blunt abdominal trauma by a heavy bag of cement. In physical examination, there was a mild abdominal tenderness on right upper quadrant. On bedside ultrasonography, there was small free fluid in his Morison’s pouch without hypotension. So abdominal CT scan was performed which revealed free fluid in pelvic, perihepatic, and perisplenic spaces. Mural hematoma of proximal part of jejunum with mural wall hypodensity in mid jejunal loop were also revealed. The patient underwent surgery, and there was damage to the colon serosa and jejunal perforation which was primarily repaired. Conclusion: The presented case highlights the importance of obtaining history and physical exam and paying attention to the nature and mechanism of injury. Emergency physicians should be aware of hollow viscus injury in traumatic patients. Any delay in diagnosis and operative management are associated with an increase in mortality.
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19
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Lee JY, Cho DH, Lee JG, Shin H, Lee YJ, Lee SH. A nomogram predicting the need for abdominal and pelvic computed tomography in blunt trauma patients: A retrospective cohort study. Int J Surg 2017; 47:127-134. [PMID: 28964934 DOI: 10.1016/j.ijsu.2017.09.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/20/2017] [Accepted: 09/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Abdominal and pelvic computed tomography (APCT) has become the preferred means for the initial evaluation of blunt trauma patients. However, computed tomography examination has some disadvantages, such as radiation exposure, the requirement for intravenous iodinated contrast medium, high cost, and time. We aimed to develop a nomogram to predict the need for APCT scanning after the primary survey of blunt trauma patients. MATERIALS AND METHODS We conducted a retrospective observational cohort study at a single-center and reviewed medical records of 972 trauma patients admitted between January 2013 and June 2016. We enrolled 786 blunt trauma patients who had undergone APCT and were 16 years of age or older. A multivariate logistic regression model was used to determine independent predictors for trauma-related findings on APCT scans. A nomogram was constructed to predict injury on APCT scans based on each predictive factor. RESULTS Of 786 patients, 355 (45%) patients had at least 1 injury on APCT scans. Results of multivariate logistic regression analysis showed that independent predictive factors of injuries on APCT scans were as follows: falls (≥3 m high); pain (abdominal, back, flank, or pelvic); positive peritoneal signs; abnormal findings on chest radiographs; abnormal findings on pelvic radiographs; and positive findings on focused assessment with ultrasonography for trauma. The nomogram was developed using these parameters. The area under a receiver operating characteristic curve of the multivariate model for discrimination was 0.865 (95% confidence interval, 0.840-0.892). The calibration plot showed good agreement between predicted and observed outcomes. The maximal Youden index was 0.59, corresponding to a cutoff value > 59 points, which was considered the optimal cutoff value for the probability that the injury would be detected on APCT scans. CONCLUSION The nomogram, based on initial clinical findings in blunt trauma patients, will help clinicians be more selective in their use of APCT evaluations.
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Affiliation(s)
- Jin Young Lee
- Department of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea.
| | - Dae Hyun Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea; Trauma Training Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
| | - Jae Gil Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea; Trauma Training Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
| | - Hyejung Shin
- Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Yeon Ju Lee
- Trauma Training Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
| | - Seung Hwan Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea; Trauma Training Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
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20
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Abstract
In the last 30 years, the management of liver injury has evolved significantly. The advancement of imaging studies has played an important role in the conservative approach for management. A shift from operative to nonoperative management for most hemodynamically stable patients with hepatic injury has been prompted by speed and sensitivity of diagnostic imaging and by advances in critical care monitoring. In this review article, the up-to-date recommendation on the management approach of liver trauma will be discussed.
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Affiliation(s)
- Hanan M Alghamdi
- Department of Surgery, King Fahd Hospital of the University, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
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21
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Abstract
The management of blunt abdominal trauma has evolved over time. While laparotomy is the standard of care in hemodynamically unstable patients, stable patients are usually treated by non-operative management (NOM), incorporating adjuncts such as interventional radiology. However, although NOM has shown good results in solid organ injuries, other lesions, namely those involving the hollow viscus, diaphragm, and mesentery, do not qualify for this approach and need surgical exploration. Laparoscopy can substantially reduce additional surgical aggression. It has both diagnostic and therapeutic potential and, when negative, may reduce the number of unnecessary laparotomies. Although some studies have shown promising results on the use of laparoscopy in blunt abdominal trauma, randomized controlled studies are lacking. Laparoscopy requires adequate training and experience as well as sufficient staffing and equipment.
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Affiliation(s)
- Viktor Justin
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - Selman Uranues
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
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22
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Surgical Problems of the Digestive System. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Yu DTY, Ngo TL, Goldstein M. Child Abuse—A Review of Inflicted Intraoral, Esophageal, and Abdominal Visceral Injuries. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Zaboli R, Tofighi S, Aghighi A, Shokouh SJH, Naraghi N, Goodarzi H. Barriers Against Implementing Blunt Abdominal Trauma Guidelines in a Hospital: A Qualitative Study. Electron Physician 2016; 8:2793-2801. [PMID: 27757191 PMCID: PMC5053462 DOI: 10.19082/2793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/18/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction Clinical practice guidelines are structured recommendations that help physicians and patients to make proper decisions when dealing with a specific clinical condition. Because blunt abdominal trauma causes a various range of mild, single-system, and multisystem injuries, early detection will help to reduce mortality and resulting disability. Emergency treatment should be initiated based on CPGs. This study aimed to determine the variables affecting implementing blunt abdominal trauma CPGs in an Iranian hospital. Methods This study was conducted as a qualitative and phenomenology study in the Family Hospital in Tehran (Iran) in 2015. The research population included eight experts and key people in the area of blunt abdominal trauma clinical practice guidelines. Sampling was based on purposive and nonrandom methods. A semistructured interview was done for the data collection. A framework method was applied for the data analysis by using Atlas.ti software. Results After framework analyzing and various reviewing and deleting and combining the codes from 251 codes obtained, 15 families and five super families were extracted, including technical knowledge barriers, economical barriers, barriers related to deployment and monitoring, political will barriers, and managing barriers. Conclusion Structural reform is needed for eliminating the defects available in the healthcare system. As with most of the codes, subconcepts and concepts are classified into the field of human resources; it seems that the education and knowledge will be more important than other resources such as capital and equipment.
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Affiliation(s)
- Rouhollah Zaboli
- Ph.D. of Health Services Administration, Assistant Professor, Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Shahram Tofighi
- Ph.D. of Health Services Administration, Assistant Professor, Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Aghighi
- Ph.D. of Health Services Administration, Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Nader Naraghi
- Assistant professor, AJA University of Medical Science, Tehran, Iran
| | - Hassan Goodarzi
- MD, Emergency Medicine Department, Baqiyatallah University of Medical Sciences, Tehran, Iran
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25
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Jones TS, Stovall RT, Jones EL, Knepper B, Pieracci FM, Fox CJ, Moore EE, Cothren Burlew C. A negative urinalysis is associated with a low likelihood of intra-abdominal injury after blunt abdominal trauma. Am J Surg 2016; 213:69-72. [PMID: 27452187 DOI: 10.1016/j.amjsurg.2016.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 04/28/2016] [Accepted: 05/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The utility of urinalysis (UA) to diagnose intra-abdominal (IA) or genitourinary (GU) injury after blunt trauma remains controversial. The purpose of this study was to determine the significance of UA in the blunt trauma patient. METHODS A retrospective review of patients admitted for blunt abdominal trauma from 2011 to 2013. RESULTS A total of 1,795 patients sustained blunt abdominal trauma: mean age of 44 ± 21 years; mean Injury Severity Score of 13 ± 10. Overall 810 patients had a negative UA (45%). Two patients (2/810 and .2%) had a GU injury and neither required intervention. Thirty-two patients (32/810 and 4.0%) had an IA injury, and 2 (2/810 and .02%) required intervention. The sensitivity for predicting GU injury requiring intervention was 1, and IA injury requiring intervention was .96. Negative predictive values were 1 and .99. CONCLUSIONS A negative UA correlates with a low risk for GU and IA injury after blunt abdominal trauma. A negative UA should be evaluated prospectively as part of a clinical prediction score to rule out injury and avoid unnecessary radiation exposure from computed tomography imaging.
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Affiliation(s)
- Teresa S Jones
- Department of Surgery, Denver Health Medical Center, the University of Colorado School of Medicine, 777 Bannock Street, MC 0206, Denver, CO 80204, USA
| | - Robert T Stovall
- Department of Surgery, Denver Health Medical Center, the University of Colorado School of Medicine, 777 Bannock Street, MC 0206, Denver, CO 80204, USA
| | - Edward L Jones
- Department of Surgery, Denver Health Medical Center, the University of Colorado School of Medicine, 777 Bannock Street, MC 0206, Denver, CO 80204, USA
| | - Bryan Knepper
- Department of Surgery, Denver Health Medical Center, the University of Colorado School of Medicine, 777 Bannock Street, MC 0206, Denver, CO 80204, USA
| | - Fredric M Pieracci
- Department of Surgery, Denver Health Medical Center, the University of Colorado School of Medicine, 777 Bannock Street, MC 0206, Denver, CO 80204, USA
| | - Charles J Fox
- Department of Surgery, Denver Health Medical Center, the University of Colorado School of Medicine, 777 Bannock Street, MC 0206, Denver, CO 80204, USA
| | - Ernest E Moore
- Department of Surgery, Denver Health Medical Center, the University of Colorado School of Medicine, 777 Bannock Street, MC 0206, Denver, CO 80204, USA
| | - Clay Cothren Burlew
- Department of Surgery, Denver Health Medical Center, the University of Colorado School of Medicine, 777 Bannock Street, MC 0206, Denver, CO 80204, USA.
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Carpenter CR, Raja AS, Brown MD. Overtesting and the Downstream Consequences of Overtreatment: Implications of "Preventing Overdiagnosis" for Emergency Medicine. Acad Emerg Med 2015; 22:1484-92. [PMID: 26568269 DOI: 10.1111/acem.12820] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/03/2015] [Accepted: 07/07/2015] [Indexed: 12/15/2022]
Abstract
Overtesting, the downstream consequences of overdiagnosis, and overtreatment of some patients are topics of growing debate within emergency medicine (EM). The "Preventing Overdiagnosis" conference, hosted by The Dartmouth Institute for Health Policy and Clinical Practice, with sponsorship from consumer organizations, medical journals, and academic institutions, is evidence of an expanding interest in this topic. However, EM represents a compellingly unique environment, with increased decision density tied to high stakes for patients and providers with missed or delayed diagnoses in a professional atmosphere that does not tolerate mistakes. This article reviews the relevance of this reductionist paradigm to EM, provides a first-hand synopsis of the first "Preventing Overdiagnosis" conference, and assesses barriers to moving the concept of less test ordering to reality.
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Affiliation(s)
- Christopher R. Carpenter
- Division of Emergency Medicine; Washington University in St. Louis School of Medicine; St. Louis MO
| | - Ali S. Raja
- Department of Emergency Medicine; Brigham & Women's Hospital; Boston MA
| | - Michael D. Brown
- Emergency Medicine; Michigan State University College of Medicine; Grand Rapids MI
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27
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Corwin MT, Fananapazir G, Lamba R, Salcedo ES, Holmes JF. Arterial phase CT for the detection of splenic injuries in blunt trauma: would it improve clinical outcomes? Clin Imaging 2015; 40:212-6. [PMID: 26995572 DOI: 10.1016/j.clinimag.2015.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 10/10/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine if the addition of an arterial phase abdominal computed tomography (CT) improves clinical outcomes in patients with blunt splenic injuries. METHODS Retrospective review of patients who underwent CT of the abdomen revealing splenic injuries. Clinical management in these patients was determined. RESULTS Fifty-one of three thousand five hundred twenty-five patients had splenic injuries. Twenty-five patients underwent nonsurgical management, and 3 failed. The theoretical additional arterial phase resulted in a 62% increase in mean effective dose compared to the portal venous phase alone. CONCLUSIONS Routine use of arterial phase CT in blunt trauma patients may not be warranted as there is minimal improvement in outcomes.
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Affiliation(s)
- Michael T Corwin
- University of California, Davis Medical Center, Department of Radiology, 4860 Y Street, ACC Suite 3100, Sacramento, CA 95817.
| | - Ghaneh Fananapazir
- University of California, Davis Medical Center, Department of Radiology, 4860 Y Street, ACC Suite 3100, Sacramento, CA 95817
| | - Ramit Lamba
- University of California, Davis Medical Center, Department of Radiology, 4860 Y Street, ACC Suite 3100, Sacramento, CA 95817
| | - Edgardo S Salcedo
- University of California, Davis Medical Center, Department of Surgery, 2315 Stockton Blvd., Sacramento, CA 95817
| | - James F Holmes
- University of California, Davis Medical Center, Department of Emergency Medicine, 4150V Street, PSSB Suite 2100, Sacramento, CA 95817
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28
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Coleman B, Ramakrishnan K. Surgical Problems of the Digestive System. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_100-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Agrusa A, Romano G, Frazzetta G, Amato G, Chianetta D, Di Giovanni S, De Vita G, Di Buono G, Sorce V, Gulotta G. The aid of “bedside ultrasonography” for the emergency surgeon: the experience of a single centre. Crit Ultrasound J 2014. [PMCID: PMC4147841 DOI: 10.1186/2036-7902-6-s2-a3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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30
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Mehta N, Babu S, Venugopal K. An experience with blunt abdominal trauma: evaluation, management and outcome. Clin Pract 2014; 4:599. [PMID: 25332759 PMCID: PMC4202181 DOI: 10.4081/cp.2014.599] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 05/24/2014] [Accepted: 05/27/2014] [Indexed: 11/23/2022] Open
Abstract
Blunt abdominal trauma (BAT) is a frequent emergency and is associated with significant morbidity and mortality in spite of improved recognition, diagnosis and management. Trauma is the second largest cause of disease accounting for 16% of global burden. The World Health Organization estimates that, by 2020, trauma will be the first or second leading cause of years of productive life lost for the entire world population. This study endeavors to evaluate 71 cases of BAT with stress on early diagnosis and management, increase use of non operative management, and time of presentation of patients. A retrospective analysis of 71 patients of BAT who were admitted in Kempegowda Institute of Medical Sciences hospital (KIMS, Bangalore, India) within a span of 18 months was done. Demographic data, mechanism of trauma, management and outcomes were studied. Most of the patients in our study were in the age group of 21-30 years with an M:F ratio of 3.7:1. Motor vehicle accident (53%) was the most common mechanism of injury. Spleen (53%) was the commonest organ injured and the most common surgery performed was splenectomy (30%). Most common extra abdominal injury was rib fracture in 20%. Mortality rate was 4%. Wound sepsis (13%) was the commonest complication. Initial resuscitation measures, thorough clinical examination and correct diagnosis forms the most vital part of management. 70% of splenic, liver and renal injuries can be managed conservatively where as hollow organs need laparotomy in most of the cases. The time of presentation of patients has a lot to do with outcome. Early diagnosis and prompt treatment can save many lives.
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Affiliation(s)
- Nikhil Mehta
- Department of General Surgery, Kempegowda Institute of Medical Sciences, Bangalore, India
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Slutzman JE, Arvold LA, Rempell JS, Stone MB, Kimberly HH. Positive FAST without hemoperitoneum due to fluid resuscitation in blunt trauma. J Emerg Med 2014; 47:427-9. [PMID: 24874045 DOI: 10.1016/j.jemermed.2014.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 04/22/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The focused assessment with sonography in trauma (FAST) examination is an important screening tool in the evaluation of blunt trauma patients. OBJECTIVES To describe a case of a hemodynamically unstable polytrauma patient with positive FAST due to fluid resuscitation after blunt trauma. CASE REPORT We describe a case of a hemodynamically unstable polytrauma patient who underwent massive volume resuscitation prior to transfer from a community hospital to a trauma center. On arrival at the receiving institution, the FAST examination was positive for free intraperitoneal fluid, but no hemoperitoneum or significant intra-abdominal injuries were found during laparotomy. In this case, it is postulated that transudative intraperitoneal fluid secondary to massive volume resuscitation resulted in a positive FAST examination. CONCLUSION This case highlights potential issues specific to resuscitated trauma patients with prolonged transport times. Further study is likely needed to assess what changes, if any, should be made in algorithms to address the effect of prior resuscitative efforts on the test characteristics of the FAST examination.
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Affiliation(s)
- Jonathan E Slutzman
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lisa A Arvold
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua S Rempell
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael B Stone
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Heidi H Kimberly
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Utilization of a clinical prediction rule for abdominal-pelvic CT scans in patients with blunt abdominal trauma. Emerg Radiol 2014; 21:571-6. [PMID: 24838812 DOI: 10.1007/s10140-014-1233-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/04/2014] [Indexed: 10/25/2022]
Abstract
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. The CP rule was negative if all variables were negative. Acute intervention was defined as therapeutic laparotomy or angiographic embolization. All variables in the CP rule were obtained in 218/262 (83 %; 95 % confidence interval (CI), 78, 88 %) patients. Of the 44 patients without complete CP rule assessment, 1 (2.3 %; 95 % CI, 0.1 %, 12.0 %) had an IAI but did not undergo therapeutic intervention. IAI was present in 11 (6.7 %; 95 % CI, 3.4, 11.6 %) of the 165 patients with at least one CP rule positive and 4 (36 %; 95 % CI, 11, 69 %) underwent therapeutic intervention. 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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Sierzenski PR, Linton OW, Amis ES, Courtney DM, Larson PA, Mahesh M, Novelline RA, Frush DP, Mettler FA, Timins JK, Tenforde TS, Boice JD, Brink JA, Bushberg JT, Schauer DA. Applications of justification and optimization in medical imaging: examples of clinical guidance for computed tomography use in emergency medicine. Ann Emerg Med 2013; 63:25-32. [PMID: 24134958 DOI: 10.1016/j.annemergmed.2013.08.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/29/2013] [Accepted: 08/29/2013] [Indexed: 11/26/2022]
Abstract
Availability, reliability, and technical improvements have led to continued expansion of computed tomography (CT) imaging. During a CT scan, there is substantially more exposure to ionizing radiation than with conventional radiography. This has led to questions and critical conclusions about whether the continuous growth of CT scans should be subjected to review and potentially restraints or, at a minimum, closer investigation. This is particularly pertinent to populations in emergency departments, such as children and patients who receive repeated CT scans for benign diagnoses. During the last several decades, among national medical specialty organizations, the American College of Emergency Physicians and the American College of Radiology have each formed membership working groups to consider value, access, and expedience and to promote broad acceptance of CT protocols and procedures within their disciplines. Those efforts have had positive effects on the use criteria for CT by other physician groups, health insurance carriers, regulators, and legislators.
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Affiliation(s)
- Paul R Sierzenski
- Section of Emergency Ultrasound, Department of Emergency Medicine, Christiana Care Health Services, Newark, DE.
| | | | - E Stephen Amis
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - D Mark Courtney
- Department of Emergency Medicine, Northwestern University, Chicago, IL
| | | | - Mahadevappa Mahesh
- Russel H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert A Novelline
- Harvard Medical School and Emergency Radiology Division, Massachusetts General Hospital, Boston, MA
| | - Donald P Frush
- Division of Pediatric Radiology, Duke University Medical Center, Durham, NC
| | - Fred A Mettler
- Department of Radiology, New Mexico VAHCS, Albuquerque, NM
| | | | - Thomas S Tenforde
- National Council on Radiation Protection and Measurements, Bethesda, MD
| | - John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD
| | - James A Brink
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Jerrold T Bushberg
- Department of Radiology, University of California, Davis, Sacramento, CA
| | - David A Schauer
- National Council on Radiation Protection and Measurements, Bethesda, MD
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Sierzenski PR, Linton OW, Amis ES, Courtney DM, Larson PA, Mahesh M, Novelline RA, Frush DP, Mettler FA, Timins JK, Tenforde TS, Boice JD, Brink JA, Bushberg JT, Schauer DA. Applications of justification and optimization in medical imaging: examples of clinical guidance for computed tomography use in emergency medicine. J Am Coll Radiol 2013; 11:36-44. [PMID: 24135540 DOI: 10.1016/j.jacr.2013.09.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Availability, reliability, and technical improvements have led to continued expansion of computed tomography (CT) imaging. During a CT scan, there is substantially more exposure to ionizing radiation than with conventional radiography. This has led to questions and critical conclusions about whether the continuous growth of CT scans should be subjected to review and potentially restraints or, at a minimum, closer investigation. This is particularly pertinent to populations in emergency departments, such as children and patients who receive repeated CT scans for benign diagnoses. During the last several decades, among national medical specialty organizations, the American College of Emergency Physicians and the American College of Radiology have each formed membership working groups to consider value, access, and expedience and to promote broad acceptance of CT protocols and procedures within their disciplines. Those efforts have had positive effects on the use criteria for CT by other physician groups, health insurance carriers, regulators, and legislators.
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Affiliation(s)
- Paul R Sierzenski
- Section of Emergency Ultrasound, Department of Emergency Medicine, Christiana Care Health Services, Newark, Delaware.
| | | | - E Stephen Amis
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - D Mark Courtney
- Department of Emergency Medicine, Northwestern University, Chicago, Illinois
| | - Paul A Larson
- Radiology Associates of the Fox Valley, Neenah, Wisconsin
| | - Mahadevappa Mahesh
- Russel H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert A Novelline
- Harvard Medical School and Emergency Radiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Donald P Frush
- Division of Pediatric Radiology, Duke University Medical Center, Durham, North Carolina
| | - Fred A Mettler
- Department of Radiology, New Mexico VAHCS, Albuquerque, New Mexico
| | | | - Thomas S Tenforde
- National Council on Radiation Protection and Measurements, Bethesda, Maryland
| | - John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, Maryland
| | - James A Brink
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jerrold T Bushberg
- Department of Radiology, University of California, Davis, Sacramento, California
| | - David A Schauer
- National Council on Radiation Protection and Measurements, Bethesda, Maryland
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Focused Assessment with Sonography in Trauma and Abdominal Computed Tomography Utilization in Adult Trauma Patients: Trends over the Last Decade. Emerg Med Int 2013; 2013:678380. [PMID: 24073336 PMCID: PMC3773453 DOI: 10.1155/2013/678380] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/29/2013] [Indexed: 11/19/2022] Open
Abstract
Objective. We sought to describe the trend in abdominal CT use in adult trauma patients after a point-of-care emergency ultrasound program was introduced. We hypothesized that abdominal CT use would decrease as FAST use increased. Methods. We performed a retrospective study of 19940 consecutive trauma patients over the age of 18 admitted to our level one trauma center from 2002 through 2011. Data was collected retrospectively and recorded in a trauma registry. We plotted the rate of FAST and abdominal CT utilization over time. Head CT was used as a surrogate for overall CT utilization rates during the study period. Results. Use of FAST increased by an average of 2.3% (95% CI 2.1 to 2.5, P < 0.01) while abdominal CT use decreased by the same rate annually. The percentage of patients who received FAST as the sole imaging modality for the abdomen rose from 2.0% to 21.9% while those who only received an abdominal CT dropped from 21.7% to 2.3%. Conclusions. Abdominal CT use in our cohort declined while FAST utilization grew in the last decade. The rising use of FAST may have played a role in the reduction of abdominal CT performed as decline in CT utilization appears contrary to overall trends.
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Dinh MM, Hsiao KH, Bein KJ, Roncal S, Saade C, Chi KF, Waugh R. Use of computed tomography in the setting of a tiered trauma team activation system in Australia. Emerg Radiol 2013; 20:393-400. [PMID: 23576264 DOI: 10.1007/s10140-013-1124-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/25/2013] [Indexed: 11/30/2022]
Abstract
This study aims to describe the patterns in the use of computed tomography (CT) imaging in the setting of a two-tiered trauma team activation system without a mandatory whole-body ("panscan") trauma CT protocol. A prospective study was conducted at a single inner city major trauma centre in Sydney, Australia. Adult patients presenting to the emergency department requiring a trauma team activation were studied over 1 year. Patients in the trauma consult group met predetermined criteria for mechanism of injury without vital sign abnormalities or clinical evidence of major injury. Full trauma team response patients were those who had abnormal predetermined vital signs or evidence of major injury on initial assessment. The outcomes measured were severe injury, multiregion injury and positive CT scans. Of the patients, 1,058 were studied of whom 63 % had at least one CT scan performed. The most common CT studies were CT brain in combination with cervical spines (23 %) and isolated abdominal CT scans (17 %). The full trauma response group was associated with significantly higher rates of severe injury (34 versus 8 %, p<0.001), multiregion injury (13 versus 3 %, p<0.001), need for operative intervention (37 versus 15 %, p<0.001) and in-hospital mortality (4 versus 0.7 %, p<0.001). This group was also associated with significantly higher odds of whole-body CT use [odds ratio (OR) 5.6, 95 % confidence interval (CI) 3.6-8.8, p<0.001] and higher odds of positive CT brain studies compared to the trauma consult group (OR 2.6, 95 % CI 1.7-4.1, p<0.001). A tiered trauma team activation criteria in combination with trauma team assessment may be used to triage patients requiring CT without the need for mandatory CT protocols based on mechanism alone.
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Affiliation(s)
- Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia,
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Ability of a new pocket echoscopic device to detect abdominal and pleural effusion in blunt trauma patients. Am J Emerg Med 2013; 31:437-9. [PMID: 23407034 DOI: 10.1016/j.ajem.2012.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 11/12/2012] [Accepted: 11/13/2012] [Indexed: 11/22/2022] Open
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When do clinical decision rules improve patient care? Ann Emerg Med 2013; 62:132-5. [PMID: 23548403 DOI: 10.1016/j.annemergmed.2013.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 11/23/2022]
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Abstract
Sports medicine physicians should be aware of the many injuries that are associated with blunt abdominal trauma. From benign diaphragmatic spasms and rectus abdominis hematomas to the more concerning liver, splenic, renal, and pancreatic injuries, the sideline physician needs to be able to triage athletic-related injuries. Furthermore, many athletes will ask their physician about return-to-play recommendations and continuing care following blunt abdominal trauma. The sports medicine physician should have a working knowledge of the pathophysiology of various abdominal injuries to best advise and treat his or her team members.
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Affiliation(s)
- Jessica M Intravia
- School of Medicine, University of Connecticut School of Medicine, Farmington, CT 06034-4037, USA.
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Screening ultrasonography of 2,204 patients with blunt abdominal trauma in the Wenchuan earthquake. J Trauma Acute Care Surg 2012; 73:890-4. [DOI: 10.1097/ta.0b013e318256dfe1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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