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FIGUEROA-GIRALT M, TORREALBA A, GONZALEZ T, ALMEIDA P, BRAGHETTO I, CSENDES A. RISK FACTORS FOR REOPERATION, MORBIDITY, AND MORTALITY IN PATIENTS WITH SMALL BOWEL OBSTRUCTION SUBMITTED TO SURGICAL TREATMENT. ABCD. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA (SÃO PAULO) 2022; 35:e1654. [PMID: 35730883 PMCID: PMC9254601 DOI: 10.1590/0102-672020210002e1654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022]
Abstract
ABSTRACT - BACKGROUND: Small bowel obstruction (SBO) is a frequent cause of emergency department admissions. AIM: This study aimed to determine risk factors of reoperations, postoperative adverse event, and operative mortality (OM) in patients surgically treated for SBO. METHODS: This is a retrospective study conducted between 2014 and 2017. Exclusion criteria include gastric outlet obstruction, large bowel obstruction, and incomplete clinical record. STATA version 14 was used for statistical analysis, with p-value <0.05 with 95% confidence interval considered statistically significant. RESULTS: A total of 218 patients were included, in which 61.9% were women. Notably, 88.5% of patients had previous abdominal surgery. Intestinal resection was needed in 28.4% of patients. Postoperative adverse event was present in 28.4%, reoperation was needed in 9.2% of cases, and a 90-day surgical mortality was 5.9%. Multivariate analysis determined that intestinal resection, >3 days in intensive care unit (ICU), >7 days with nasogastric tube (NGT), pain after postoperative day 3, POAE, and surgical POAE were the risk factors for reoperations, while age, C-reactive protein, intestinal resection, >3 days in ICU, and >7 days with NGT were the risk factors for POAE. OM was determined by >5 days with NGT and POAE. CONCLUSIONS: Postoperative course is determined mainly for patient’s age, preoperative level of C-reactive protein, necessity of intestinal resection, clinical postoperative variables, and the presence of POAE.
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Choinski K, Sanon O, Tadros R, Koleilat I, Phair J. Review of Malpractice Lawsuits in the Diagnosis and Management of Aortic Aneurysms and Aortic Dissections. Vasc Endovascular Surg 2021; 56:33-39. [PMID: 34159854 DOI: 10.1177/15385744211026455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Aortic aneurysms and dissections are prevalent causes of morbidity and mortality. The management of aortic pathologies may be called into question in malpractice suits. Malpractice claims were analyzed to understand common reasons for litigation, medical specialties involved, patient injuries, and outcomes. METHODS Litigation cases in the Westlaw database from September 1st, 1987 to October 23 rd, 2019 were analyzed. Search terms included "aortic aneurysm" and "aortic dissection." Data on plaintiff, defendant, litigation claims, patient injuries, misdiagnoses, and case outcomes were collected and compared for aortic aneurysms, aortic dissections, and overall cases. RESULTS A total of 346 cases were identified, 196 involving aortic aneurysms and 150 aortic dissections. Physician defendants were emergency medicine (29%), cardiology (20%), internal medicine (14%), radiology (11%), cardiothoracic (10%) and vascular surgery (10%). Litigation claims included "failure to diagnose and treat" (61%), "delayed diagnosis and treatment" (21%), "post-operative complications after open repair" (10%) and "negligent post-operative care" (10%). Patients with aneurysms presented with abdominal (63%) and back pain (37%), while dissections presented with chest pain (78%), abdominal pain (15%), and shortness of breath (14%). Misdiagnoses included gastrointestinal (12%), other cardiovascular (9%), and musculoskeletal conditions (9%), but many were not specified (58%). Overall, 83% of cases were wrongful death suits. Injuries included loss of consortium (23%), emotional distress (19%), and bleeding (17%). In 53% of the cases, the jury ruled in favor of the defendant. 25% of cases ruled for the plaintiff. 22% of cases resulted in a settlement. The mean rewarded for each case was $1,644,590.66 (SD: $5,939,134.58; Range: $17,500-$68,035,462). CONCLUSION For aortic pathologies, post-operative complications were not prominent among the reasons why suits were brought forth. This suggests improvements in education across all involved medical specialties may allow for improved diagnostic accuracy and efficient treatment, which could then translate to a decrease in associated litigation cases.
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Affiliation(s)
- Krystina Choinski
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Omar Sanon
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rami Tadros
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Issam Koleilat
- Department of Surgery, Community Medical Center, RWJ/Barnabus Health, Tom's River, NJ, USA
| | - John Phair
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Donlon NE, Kelly ME, Zafar M, Boland PA, Davis C, Wei Teh J, Corless K, Khan W, Khan I, Waldron R, Barry K. The Use of Clinical Parameters as Adjuncts to Endoscopic Evaluation of Mural Thickening on Conventional Computed Tomography in Diagnosing Malignancy. Dig Surg 2021; 38:230-236. [PMID: 33784697 DOI: 10.1159/000514777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 01/19/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND Mural thickening (MT) on computed tomography (CT) poses a diagnostic dilemma in the absence of clear reporting guidelines. The aim of this study was to analyse CT reports, identifying patients in whom gastrointestinal wall MT was observed, and to correlate these reports with subsequent endoscopic evaluation. METHODS Patients with MT who had follow-up endoscopy were included in the study (n = 308). The cohort was subdivided into upper gastrointestinal mural thickening (UGIMT) & lower gastrointestinal mural thickening (LGIMT). RESULTS In total, 55.71% (n = 122) of colonoscopies and 61.8% (n = 55) of gastroscopies were found to be normal. Haemoglobin (HB) level in combination with MT was a predictor of neoplasia in both arms (p = 0.04 UGIMT cohort, p < 0.001 LGIMT cohort). In addition to this, age was a significant correlative parameter in both UGIMT and LGIMT cohorts (p = 0.003, p < 0.001 respectively). Dysphagia and weight loss were associated with UGI malignancies (38 and 63% respectively) and rectal bleeding was correlative in 20% of patients with LGI malignancies. CONCLUSION HB, advancing age, and red flag symptoms are potentially useful adjuncts to MT in predicting upper and lower gastrointestinal malignancies. We propose the adoption of a streamlined pathway to delineate patients who should undergo endoscopic investigation following CT identification of MT.
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Affiliation(s)
- Noel E Donlon
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Michael E Kelly
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Muneeb Zafar
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Patrick A Boland
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Cian Davis
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Jia Wei Teh
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Kevin Corless
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Waqar Khan
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Iqbal Khan
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Ronan Waldron
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Kevin Barry
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland.,Discipline of Surgery National University of Ireland, Galway, Ireland
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Herpe G, Boucebci S, Cassan T, Verdier M, Simonet C, Sztark G, Tasu JP. Portal phase alone is equivalent to multiphasic phase for CT diagnosis of acute non-traumatic pains in an emergency context. Emerg Radiol 2019; 27:151-156. [PMID: 31781984 DOI: 10.1007/s10140-019-01742-8] [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: 05/24/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate radiological diagnosis concordance between a simplified and a multiphasic computed tomography (MCT) protocol for patients presenting acute non-traumatic abdominal pains (ANTAE). METHODS During five consecutive months, all patients admitted in an emergency department for ANTAE were retrospectively included if they underwent MCT, including at least pre-contrast phase, late arterial phase (LAP), and portal venous phase (PVP). Clinical cases of suspected hemorrhagic conditions were secondarily excluded. For the study, two image sets, pre-contrast phase + LAP + PVP ± late phase called S1 and PVP alone called S2, were reviewed independently to give the most appropriate diagnosis with 5-point confidence scale. Diagnosis concordance and radiation dose were compared for each set of protocol by chi-square test. Linear mixed model was used to assess changes of diagnostic confidence and radiation dose. RESULTS All in all, 196 patients were included. The kappa coefficient between S1 and S2 was excellent (98.5%, CI95% 95.6-99.7). Three errors due to an inappropriate protocol were observed (1.5%; CI95% = - 0.2 to 3.2%), 2 related to biliary tract obstruction causes and one due to gastric bleeding not suspected on clinical data. S2 was associated with a 61% decrease of the radiation dose (p = 0.01) with a mild decrease of the confidence scale (4.54 ± 0.05 versus 4.74 ± 0.03, p = 0.001). CONCLUSION Using PVP-CT alone or MCT is equivalent for the diagnosis of ANTAE if suspected acute hemorrhages are excluded. A simplified CT protocol is associated with a dose decrease of 61%.
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Affiliation(s)
- Guillaume Herpe
- Department of Radiology, Poitiers University Hospital, rue de la milétrie, 86000, Poitiers, France
| | - Samy Boucebci
- Department of Radiology, Poitiers University Hospital, rue de la milétrie, 86000, Poitiers, France
| | - Tiphaine Cassan
- Department of Radiology, Poitiers University Hospital, rue de la milétrie, 86000, Poitiers, France
| | - Marine Verdier
- Department of Radiology, Poitiers University Hospital, rue de la milétrie, 86000, Poitiers, France
| | - Charles Simonet
- Department of Radiology, Poitiers University Hospital, rue de la milétrie, 86000, Poitiers, France
| | - Guillaume Sztark
- Department of Radiology, Poitiers University Hospital, rue de la milétrie, 86000, Poitiers, France
| | - Jean Pierre Tasu
- Department of Radiology, Poitiers University Hospital, rue de la milétrie, 86000, Poitiers, France. .,La TIM, INSERM U1101, INSERM-UBO UMR 1101, CHRU Morvan - 2, Av. Foch, 29609, Brest CEDEX, France. .,Service de Radiologie, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France.
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Zitek T, Pellman L, Uribe J, Guillen A. Pain Scores Are Not Predictive of Radiographically Evident Intraabdominal Pathology in Patients With Abdominal Pain. Acad Emerg Med 2019; 26:1169-1172. [PMID: 31365769 DOI: 10.1111/acem.13841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Tony Zitek
- Nova Southeastern University School of Allopathic Medicine Fort Lauderdale FL
- Kendall Regional Medical Center Miami FL
- University Medical Center of Southern Nevada Las VegasNV
- University of Nevada, Las Vegas School of Medicine Las Vegas NV
| | - Lauren Pellman
- University of Nevada, Las Vegas School of Medicine Las Vegas NV
| | - Jessica Uribe
- University Medical Center of Southern Nevada Las VegasNV
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Abdoolraheem MY, Quraishi MK, Tonsi A, Henderson A. Caecal volvulus following left-side laparoscopic retroperitoneal nephroureterectomy. BMJ Case Rep 2019; 12:12/7/e228878. [PMID: 31278197 DOI: 10.1136/bcr-2018-228878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Caecal volvulus is an uncommon cause of intestinal obstruction, with a high associated morbidity and mortality. Caecal volvulus is a very rare complication following retroperitoneal surgery. As such, a high degree of clinical suspicion is warranted post operatively to minimise delay in definitively investigating and managing this condition. We present a case of an 80-year-old Caucasian woman who was admitted for an elective left-sided laparoscopic retroperitoneal nephroureterectomy for transitional cell carcinoma of the left upper pole renal calyx. Postoperatively, the patient developed intestinal obstruction, secondary to caecal volvulus. The patient underwent an emergency laparotomy and limited right-sided colonic resection with primary anastomosis.
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Affiliation(s)
| | | | - Alfredo Tonsi
- General Surgery, Medway Maritime Hospital, Gillingham, Kent, UK
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Importance of the physical exam: double-blind randomized controlled trial of radiologic interpretation of ventral hernias after selective clinical information. Hernia 2018; 23:987-994. [DOI: 10.1007/s10029-018-1856-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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Tonolini M, Valconi E, Vanzulli A, Bianco R. Radiation overexposure from repeated CT scans in young adults with acute abdominal pain. Emerg Radiol 2017; 25:21-27. [DOI: 10.1007/s10140-017-1554-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/08/2017] [Indexed: 12/13/2022]
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Ihuhua P, Pitcher RD. Is the devil in the detail? The quality and clinical impact of information provided on requests for non-trauma emergency abdominal CT scans. Acta Radiol 2016; 57:1217-22. [PMID: 26787676 DOI: 10.1177/0284185115626474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/09/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND The role of the radiology information system in streamlining imaging workflow and enhancing efficiency in digital radiology departments is now well established. Although there is increasing use of systems with the capacity for computerized physician order entry, there has been limited work on the quality of clinical data provided on electronic diagnostic imaging requests. PURPOSE To assess the quality of clinical details provided on electronic diagnostic imaging requests (DIR) for emergency non-trauma abdominal computed tomography (CT) scans, and the impact of such data on radiological outcomes. MATERIAL AND METHODS We conducted a retrospective analysis of 100 consecutive electronic DIRs for emergency non-trauma abdominal CT scans for patients with an acute abdomen in a tertiary-level public-sector hospital. The quality of clinical data was assessed using the Royal College of Physicians' referral guidelines and correlated with radiological outcomes, defined as a definitive CT diagnosis. RESULTS Eighty-eight percent of requests presented a clear clinical question, 48% recorded clinical examination details, 29% had adequate clinical histories, and 17% included laboratory investigations, while only 2% of requests were complete in all respects. Although 88% of scans yielded a definitive radiological diagnosis, there was no association between the adequacy of DIR details and a definitive radiological outcome. CONCLUSION Our findings underscore the non-specific clinical presentation of non-trauma-related abdominal emergencies and the pivotal role of CT in providing a definitive diagnosis in this setting. We suggest that the appropriate triage of patients presenting with an acute, non-trauma abdomen is the overriding clinical imperative.
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Affiliation(s)
- Puleinge Ihuhua
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Richard D Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
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Kulkarni GV, Salgaonkar HP, Sharma PC, Chakkarvarty NR, Katara AN, Bhandarkar DS. Laparoscopic repair of left paraduodenal hernia: Report of two cases and review of the literature. Asian J Endosc Surg 2016; 9:157-60. [PMID: 27117968 DOI: 10.1111/ases.12270] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/23/2015] [Indexed: 12/23/2022]
Abstract
Internal hernia is the cause of only 1% of intestinal obstructions, and left paraduodenal hernias (PDH) comprise about 50% of these cases. As the presentation of PDH is varied, diagnosis is often delayed. Here, we report two patients with left PDH presenting in a subacute manner and diagnosed rapidly with the help of a CT scan. Both underwent successful laparoscopic repair; one patient had closure of the defect, and the other required excision of the sac prior to the closure. We review 21 cases of left PDH treated laparoscopically that were previously reported in the literature, including 14 from Asian countries.
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Affiliation(s)
| | | | | | | | - Avinash N Katara
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, India
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Pocard M, Schmitt G, Niel S. What technical platform is needed for non-traumatic abdominal emergencies? Can we be realistic yet effective? J Visc Surg 2015; 152:S55-6. [PMID: 26507769 DOI: 10.1016/j.jviscsurg.2015.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M Pocard
- Université Paris Diderot, Sorbonne Paris Cité, CART, Inserm U965, 74575 Paris, France; AP-HP, Hôpital Lariboisière, Service de chirurgie digestive et cancérologique Clinique, 75475 Paris, France.
| | - G Schmitt
- Polyclinique Courlancy, 38 bis, rue de Courlancy, 51100 Reims, France
| | - S Niel
- Clinique de l'Île Nou-Magnin, 1, rue RP-Roman, Nouméa, Nouvelle-Calédonie, France
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Karsanov AM, Kul'chiev AA, Karaev TR, Kokaev IP, Vahotskij VV. [The role of current methods of X-ray diagnosis in case of intraabdominal suppurative complications caused bu colonic diseases]. Khirurgiia (Mosk) 2015:75-79. [PMID: 26331169 DOI: 10.17116/hirurgia2015575-79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A M Karsanov
- North Ossetian State Medical Academy, Vladikavkaz
| | | | - T R Karaev
- North Ossetian State Medical Academy, Vladikavkaz
| | - I P Kokaev
- North Ossetian State Medical Academy, Vladikavkaz
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Bjørsum-Meyer T, Schmidt TA. Consequences of peritonism in an emergency department setting. Open Access Emerg Med 2014; 6:9-13. [PMID: 27147873 PMCID: PMC4753981 DOI: 10.2147/oaem.s47798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In patients who were referred to the emergency department (ED) with abdominal pain, it is crucial to determine the presence of peritonism to allow for appropriate handling and subsequent referral to stationary departments. We aimed to assess the incidence of perceived peritonism in a contemporary ED and to make a comparable characterization on specified endpoints, including hospital stay, performed acute surgery, and ordered imaging. Methods A single-center study was performed during 2010 in a contemporary Danish ED. We evaluated 1,270 patients consecutively admitted to the ED and focused on the patients with abdominal pain. Following a physical examination, the patients with abdominal pain were divided into those who had clinical signs of peritonism and those who did not. Results Among the 1,270 patients admitted to the ED, 10% had abdominal pain. In addition, 41% of these patients were found to have signs indicative of peritonism, and 90% were admitted to the Department of Surgery (DS). Also, 24% of those patients with signs of peritonism and admission to the DS underwent surgical intervention in terms of laparotomy/laparoscopy. Five of the patients without peritonism underwent surgery. The patients perceived to have peritonism were younger at 34±3.0 years (mean ± standard error of the mean) than the patients who were not perceived to have peritonism, 52±2.8 years (P<0.05). They also had a shorter length of stay of 38.2±6.0 hours at the DS versus 95.3±18.2 hours (P<0.05). No differences with statistical significance were found regarding a stay in the emergency room (ER) or ordered imaging from the ER. Conclusion Peritonism was a common finding in our setting. Peritonism did not require more acute surgery or imaging. The duration of the patient’s stay in the ER was not influenced by a finding of peritonism. The evaluation of peritonism needs to be improved in the ED.
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Affiliation(s)
| | - Thomas A Schmidt
- Emergency Department, Holbaek Hospital, Smedelundsgade, Holbaek, Denmark
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