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Kulkarni S, Chakole S, Dubey T, Yelne S. A Rare Case of Splenic Artery Aneurysm With Unusual Combination of Pancytopenia and Massive Splenomegaly in a Tertiary Care Hospital. Cureus 2023; 15:e47940. [PMID: 38034136 PMCID: PMC10685079 DOI: 10.7759/cureus.47940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Aneurysms of the splenic artery leading to extrahepatic portal hypertension are sporadic and infrequently encountered. They typically manifest as a consequence of thrombus or embolus formation. A splenic artery aneurysm (SAA) represents a localized expansion in the diameter of the splenic artery and is one of the most prevalent forms of visceral artery aneurysms. This artery dilation is primarily attributed to pancreatitis, trauma, or atherosclerosis, commonly affecting elderly patients. Patients affected by this condition typically remain asymptomatic, except for an audible bruit over the aneurysm site, unless a rupture occurs. In the event of a rupture, early indicators include abdominal pain, hemoperitoneum, and a positive Kerr sign, all indicative of SAA rupture. Most SAAs are incidentally discovered, with CT angiography being the preferred diagnostic tool. We present the case of a 38-year-old female (gravida 1, para 1) with a previous full-term normal delivery, who presented to a rural tertiary care hospital with a two-week history of left-sided abdominal pain. A CT scan of the abdomen revealed a solitary aneurysm in the distal portion of the splenic artery, accompanied by perisplenic fluid collection resulting in splenomegaly. Given the critical risk of rupture, which can result in life-threatening bleeding, prompt and accurate diagnosis assumes paramount significance. It is worth noting that the diagnosis of SAA often occurs incidentally due to its asymptomatic nature in its early stages. We document this unique occurrence of extrahepatic SAA contributing to pancytopenia, portal hypertension, and extensive splenomegaly to provide valuable insights for medical professionals in recognizing and managing such presentations. This awareness can help prevent unnecessary diagnostic and therapeutic interventions.
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Affiliation(s)
- Shrawani Kulkarni
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swarupa Chakole
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tanishq Dubey
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Yelne
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Waheed S, Tahir MJ, Ullah I, Alwalid O, Irshad SG, Asghar MS, Yousaf Z. The impact of dependence on advanced imaging techniques on the current radiology practice. Ann Med Surg (Lond) 2022; 78:103708. [PMID: 35592825 PMCID: PMC9111924 DOI: 10.1016/j.amsu.2022.103708] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/05/2022] Open
Abstract
Medical imaging techniques are a helpful tool for physicians to diagnose and treat diseases. Some of these techniques are conventional and include X-rays, Ultrasounds while others are advanced imaging modalities such as MRI and CT scans. Recently, more and more physicians are relying on these advanced imaging modalities because of advancements in technology, increased patient demand, greater finances, and the fear of any malpractice suits in case of missed diagnosis. While these techniques, no doubt, offer a quicker and correct diagnosis owing to their sharp resolution and sensitivity, they do expose the patient to a great source of radiation, are expensive, time consuming, and are not an ideal means to be used in all situations. Thus, it is crucial to mitigate their unnecessary use. The following article focuses on the growing use of such techniques, their advantages and disadvantages and how to alleviate their exaggerated use.
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Zhu H, Lai J, Liu B, Wen Z, Xiong Y, Li H, Zhou Y, Fu Q, Yu G, Yan X, Yang X, Zhang J, Wang C, Zeng H. Automatic pulmonary auscultation grading diagnosis of Coronavirus Disease 2019 in China with artificial intelligence algorithms: A cohort study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 213:106500. [PMID: 34768234 PMCID: PMC8550891 DOI: 10.1016/j.cmpb.2021.106500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 10/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Research on automatic auscultation diagnosis of COVID-19 has not yet been developed. We therefore aimed to engineer a deep learning approach for the automated grading diagnosis of COVID-19 by pulmonary auscultation analysis. METHODS 172 confirmed cases of COVID-19 in Tongji Hospital were divided into moderate, severe and critical group. Pulmonary auscultation were recorded in 6-10 sites per patient through 3M littmann stethoscope and the data were transferred to computer to construct the dataset. Convolutional neural network (CNN) were designed to generate classifications of the auscultation. F1 score, the area under the curve (AUC) of the receiver operating characteristic curve, sensitivity and specificity were quantified. Another 45 normal patients were served as control group. RESULTS There are about 56.52%, 59.46% and 78.85% abnormal auscultation in the moderate, severe and critical groups respectively. The model showed promising performance with an averaged F1 scores (0.9938 95% CI 0.9923-0.9952), AUC ROC score (0.9999 95% CI 0.9998-1.0000), sensitivity (0.9938 95% CI 0.9910-0.9965) and specificity (0.9979 95% CI 0.9970-0.9988) in identifying the COVID-19 patients among normal, moderate, severe and critical group. It is capable in identifying crackles, wheezes, phlegm sounds with an averaged F1 scores (0.9475 95% CI 0.9440-0.9508), AUC ROC score (0.9762 95% CI 0.9848-0.9865), sensitivity (0.9482 95% CI 0.9393-0.9578) and specificity (0.9835 95% CI 0.9806-0.9863). CONCLUSIONS Our model is accurate and efficient in automatically diagnosing COVID-19 according to different categories, laying a promising foundation for AI-enabled auscultation diagnosing systems for lung diseases in clinical applications.
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Affiliation(s)
- Hongling Zhu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jinsheng Lai
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Bingqiang Liu
- School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan, Hubei 430074, China; Wuhan National Laboratory of Optoelectronics, Wuhan, Hubei 430074, China
| | - Ziyuan Wen
- School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan, Hubei 430074, China; Wuhan National Laboratory of Optoelectronics, Wuhan, Hubei 430074, China
| | - Yulong Xiong
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Honglin Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yuhua Zhou
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, China
| | - Qiuyun Fu
- School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan, Hubei 430074, China; Wuhan National Laboratory of Optoelectronics, Wuhan, Hubei 430074, China
| | - Guoyi Yu
- School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan, Hubei 430074, China; Wuhan National Laboratory of Optoelectronics, Wuhan, Hubei 430074, China
| | - Xiaoxiang Yan
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, China
| | - Xiaoyun Yang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jianmin Zhang
- School of Artificial Intelligence, Jianghan University, Wuhan, Hubei 430056, China
| | - Chao Wang
- School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan, Hubei 430074, China; Wuhan National Laboratory of Optoelectronics, Wuhan, Hubei 430074, China.
| | - Hesong Zeng
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
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Malik H, Appelboam A, Nunns M. Ultrasound-directed reduction of distal radius fractures in adults: a systematic review. Emerg Med J 2021; 38:537-542. [PMID: 33853935 DOI: 10.1136/emermed-2020-210464] [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: 07/27/2020] [Revised: 02/20/2021] [Accepted: 03/07/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To conduct a systematic review of the clinical literature to determine whether ultrasound can be used to improve the reduction of distal radius fractures in adults in the ED. METHODOLOGY A study protocol was registered on PROSPERO. EMBASE, PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov of the US National Library of Medicine were searched for studies evaluating ultrasound-assisted distal radial fracture reductions in comparison with standard care. The primary outcome of interest was manipulation success rates, defined as the proportion of fracture manipulations resulting in acceptable anatomical alignment, with secondary outcome being subsequent surgical intervention rates in ultrasound and standard care group of patients. RESULTS 248 were screened at title and abstract, and 10 studies were included for a narrative synthesis. The quality of this evidence is limited but suggests ultrasound is accurate in determining distal radius fracture reduction and may improve the quality of reduction compared with standard care. However, there is insufficient evidence to determine whether this affects the rate of subsequent surgical intervention or functional outcome. CONCLUSION There is a lack of evidence that using ultrasound in the closed reduction of distal radius fractures benefits patients. Properly conducted randomised controlled trials with patient-orientated outcomes are crucial to investigate this technology.
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Affiliation(s)
- Hamza Malik
- Emergency Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andrew Appelboam
- Emergency Department, Royal Devon and Exeter Foundation Trust, Exeter, UK
| | - Michael Nunns
- Exeter Policy Research Programme, Evidence Review Facility, Exeter, UK
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Villalobos A, Horný M, Hughes DR, Duszak R. Associations Over Time Between Paid Medical Malpractice Claims and Imaging Utilization in the United States. J Am Coll Radiol 2021; 18:34-41. [DOI: 10.1016/j.jacr.2020.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/01/2022]
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Baker M, Jaeger C, Hafley C, Waymack J. Appropriate CT cervical spine utilisation in the emergency department. BMJ Open Qual 2020; 9:bmjoq-2019-000844. [PMID: 33028655 PMCID: PMC7542617 DOI: 10.1136/bmjoq-2019-000844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 07/30/2020] [Accepted: 09/18/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Over 40 000 CT scans are performed in our emergency department (ED) annually and utilisation is over 80% capacity. Improving medical appropriateness of CT scans may reduce total number of scans, time, cost and radiation exposure. Methods Lean Six Sigma methodology was used to improve the process. A National Emergency X-Radiography Utilisation Study (NEXUS)-based PowerForm was implemented in the electronic health record and providers were educated on the criteria. Results The rate of potentially medically inappropriate CT C-spine scans decreased from 45% (19/42) to 22% (90/403) (two-proportion test, p=0.002). After the intervention, there was no longer a difference between midlevel providers and physicians in the rate of medically inappropriate orders (19% vs 22%) (two-proportion test, p=0.850) compared with that before the intervention (56% vs 31%) (two-proportion test, p<0.01). Overall rates of CT C-spine scans ordered decreased from 69.3 to 62.6/week (t-test, p=0.019). Conclusion A validated clinical decision-making tool implemented into the medical record can improve quality of care. This study lays a foundation for other imaging studies with validated support tools with similar potential improvements.
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Affiliation(s)
- Mark Baker
- Department of Emergency Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Cassie Jaeger
- Department of Operations Improvement, Memorial Health System, Springfield, Illinois, USA
| | - Carol Hafley
- Midwest Healthcare Quality Alliance, Memorial Health System, Springfield, Illinois, USA
| | - James Waymack
- Department of Emergency Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Has NICE guidance changed the management of the suspected scaphoid fracture: A survey of UK practice. Radiography (Lond) 2020; 27:377-380. [PMID: 33011069 DOI: 10.1016/j.radi.2020.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Despite scaphoid fractures being relatively uncommon pro-active treatment of suspected fractures has been seen as a risk management strategy. The poor positive predictive value of X-rays has led to published guidelines advocating MRI as a first-line or early imaging tool. It is unclear whether UK hospitals have been able to introduce early scanning and this national survey sought to establish the current management strategies for patients with a suspected scaphoid fracture. METHOD An electronic survey of UK emergency departments (ED) was conducted to establish the initial and follow up strategies for patients with negative imaging. Comparison of first and second-line imaging modalities was undertaken together with review of the clinical speciality responsible for ongoing management. RESULTS 166 UK NHS Trusts were identified with emergency department facilities of which 66 (39.8%) responded. All sites perform an X-ray as the initial examination. For those with a negative examination ED follow up was the most common approach (54.6%), although many sites refer patients to other specialities including orthopaedics (39.4%) for follow up. The data demonstrated inconsistencies in the number of follow-up episodes and the different imaging investigations utilised. Frustration with the challenges presented by this patient cohort was evident. CONCLUSION The suspected scaphoid fracture represents an ongoing challenge to the NHS with many resource intensive pathways reliant on access to complex imaging investigations. IMPLICATIONS FOR PRACTICE Our study identified that UK Emergency Departments have limited early access to complex imaging for scanning of the scaphoid. A range of strategies are used for follow up of suspected scaphoid fractures and these are resource intensive. Overtreatment of patients with suspected scaphoid fracture is used as a risk management approach.
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Johnson JR, Babu JM, Durand WM, Eltorai AEM, Patel SA, Daniels AH. Recognition and Management of Emergent Spinal Pathology Among First-Line Providers. Orthopedics 2020; 43:e244-e250. [PMID: 32271932 DOI: 10.3928/01477447-20200404-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/15/2019] [Indexed: 02/03/2023]
Abstract
Spinal emergencies require prompt identification, management, and surgical referral (if needed) from first-line providers. Diagnostic delays from a failure to recognize emergency conditions can lead to adverse patient outcomes. The objective of this study was to understand the proficiency with which first-line providers can recognize and manage spinal conditions, particularly spinal emergencies. This was a cross-sectional analysis of 143 internal medicine, family medicine, emergency care, and neurology questionnaires collected at a single-site academic center. Participants were predominantly physicians (88.1%, n=126), with a smaller percentage of midlevel providers (11.9%, n=17). Only 35.0% (n=50) of respondents felt "very prepared" to handle spinal emergencies. Bivariate analyses revealed interdepartmental differences in clinical knowledge pertaining to the management of lumbar radiculopathy (P<.0001), epidural abscess (P=.0002), and cervical myelopathy (P<.0001). Following pairwise comparisons of interdepartmental differences, emergency medicine statistically outperformed internal medicine (P=.0007) and neurology (P<.0001) on initial management of lumbar radiculopathy, while also having markedly higher success in identifying and managing epidural abscess with respect to family medicine (P<.0001). The likelihood of appropriate initial treatment of cervical myelopathy was significantly higher for neurology than for emergency medicine (P<.0001). A minority of first-line providers reported being very prepared to handle spinal emergencies. Disparities exist between first-line provider specialties regarding clinical knowledge in managing and proficiently identifying emergent and nonemergent spinal conditions. Because appropriate handling of emergent spinal pathologies is essential to patient outcomes and optimal resource use, measures should be taken to further educate first-line providers regarding the spinal conditions they will be treating. [Orthopedics. 2020;43(4):e244-e250.].
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National Trends in Imaging Rates for Eye-Related Emergency Department Visits in the United States. Am J Ophthalmol 2020; 211:114-122. [PMID: 31730840 DOI: 10.1016/j.ajo.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To identify nationwide trends and factors associated with advanced imaging (computed tomography [CT] and magnetic resonance imaging [MRI]) use for eye-related emergency department (ED) visits. DESIGN Retrospective, trend study. METHODS Setting: National Hospital Ambulatory Medical Care Survey 2007-2015. PATIENT POPULATION Eye-related ED patients who underwent CT or MRI. MAIN OUTCOME MEASURE(S) Population-based CT/MR imaging rates and independent factors associated with imaging. RESULTS An estimated 7 million eye-related ED visits occurred between 2007 and 2015. Adjusted for annual eye-related ED visits, the rate of imaging use rose 94%, from 121.7 per 1,000 eye-related ED visits in 2007 to 236.0 per 1,000 eye-related ED visits in 2015. Visual disturbances, contusion of the eye and/or adnexa, open globes and open wounds of ocular adnexa, diplopia, superficial corneal and/or conjunctival injuries, and orbital fractures accounted for 73.2% of all visits where imaging was performed. On multivariable analysis, older patients (odds ratio [OR] = 1.02, 95% confidence interval [CI] 1.01-1.03) and females (OR=2.07, 95% CI 1.18-3.63) were more likely to undergo imaging than younger patients and males. Imaging was also more likely to be performed for Medicare beneficiaries (OR=2.12, 95% CI 1.08-4.15) than for privately insured patients. Patients who were admitted to the hospital were 6 times more likely (OR=6.39, 95% CI 2.04-20.0) to undergo imaging than those who were not admitted. CONCLUSIONS Advanced imaging for eye-related ED visits has escalated at a higher rate than ED visits for eye complaints. Future studies to develop evidence-based algorithms for use of CT/MR imaging for eye complaints that can help balance benefits against financial costs and health risk are warranted.
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Hynes JP, Hunter K, Rochford M. Utilization and appropriateness in cervical spine trauma imaging: implementation of clinical decision support criteria. Ir J Med Sci 2020; 189:333-336. [DOI: 10.1007/s11845-019-02059-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/02/2019] [Indexed: 11/30/2022]
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The Increasing Use of Emergency Department Imaging in the United States: Is It Appropriate? AJR Am J Roentgenol 2019; 213:W180-W184. [PMID: 31237433 DOI: 10.2214/ajr.19.21386] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE. The purpose of this study was to study trends in utilization of imaging in emergency departments (ED) in relation to trends in ED visits and the specialties of the interpreting physicians. MATERIALS AND METHODS. This study was conducted with Medicare Part B Physician/Supplier Procedure Summary Master Files for 2004-2016 and Health Care Cost and Utilization Project (HCUP) data from 2006 to 2014. Yearly utilization was calculated per 1000 Medicare beneficiaries for different noninvasive imaging modalities performed during ED visits, and the specialties of the physicians making the interpretations were recorded. The number of ED visits by Medicare patients was obtained from the HCUP. RESULTS. The number of ED visits by Medicare fee-for-service patients increased 8.0% (from 20.0 million in 2006 to 21.6 million in 2014), and the total number of associated ED imaging examinations increased 38.4% (14.6 million to 20.2 million). The number of imaging examinations per ED visit was 0.73 in 2006, increasing to 0.94 by 2014. Utilization trends per 1000 Medicare fee-for-service enrollees in the ED for the major modalities were as follows: CT +153.0% (77.8 in 2004 to 196.7 in 2016), noncardiac ultrasound +134% (11.2 in 2004 to 26.2 in 2016), and radiography +30% (259 in 2004 to 336 in 2016). Utilization of MRI and nuclear medicine was very low. In 2016, radiologists interpreted 99.5% (CT), 99.2% (MRI), 98.0% (radiography), 87.6% (ultrasound), and 94.5% (nuclear medicine) of imaging examinations. CONCLUSION. Utilization of imaging in EDs is increasing not only in the Medicare population but also per ED visit. Radiologists strongly predominate in interpreting examinations in all modalities.
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Ultrasonography in Emergency Department; a Diagnostic Tool for Better Examination and Decision-Making. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2017; 2:e7. [PMID: 31172070 PMCID: PMC6548109 DOI: 10.22114/ajem.v0i0.40] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Context: The aim of this study is to evaluate the applications of ultrasonography (US) as a diagnostic tool in emergency settings. Evidence acquisition: In the present review article, search engines and scientific databases of Google Scholar, Science Direct, PubMed, Medline, Scopus, and Cochrane were searched for the applications of US in emergencies. Finally, related articles which were published between 2000 and 2017, were selected and by reviewing them an attempt was made to evaluate various applications of US for examining and facilitating decision-making in emergency department (ED). Results: As a diagnostic tool, US can be of diagnostic help in emergency settings for the specialists and the treatment team regarding trauma, measuring intracranial pressure (ICP), hemothorax pneumothorax, abscess and its drainage, deep vein thrombosis (DVT), dyspnea, acute abdomen, appendicitis and biliary problems, renal colic and renal stones, shock, foreign object, bone fracture, peripheral nerve block, establishing central and peripheral venous access, lumbar puncture (LP), and confirmation of nasogastric tube (NGT) and endotracheal tube (ETT) placement. Conclusion: The results of this review study showed that US can be of help to EMPs as a diagnostic tool in a wide range of diseases and clinical conditions, which in turn can result in a decrease in the time needed for diagnosis and treatment, and therefore improve both the quality and quantity of the service provided in ED.
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