Imaging

Would You Hold Still for 2 Seconds? – New Fast CT Means Less Pediatric Sedation

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Newer CT scanners led to faster head CT by about 10 seconds, and this decreased the number of pediatric patients who required sedation.

Source
Impact of a Faster Computed Tomography Scanner on Sedation for Pediatric Head Computed Tomography Scans in 2 Large Emergency Departments-A Retrospective Study. Pediatr Emerg Care. 2022 Aug 5. doi: 10.1097/PEC.0000000000002816. Online ahead of print.

Guess the Radiation Risk – Portable X-Rays in the Emergency Department

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Despite a high number of portable radiographs obtained in the ED, exposure to this ionizing radiation does not appear to be a significant occupational hazard, and existing precautions appear to be adequate.

Source
Risk of Radiation Exposure to Emergency Department Personnel From Portable Radiographs. J Emerg Med. 2022 Oct 12;S0736-4679(22)00449-8. doi: 10.1016/j.jemermed.2022.08.002. Online ahead of print.

Imaging Decisions Vary On Shift – Are We Feeling More Confident, Fatiguing, or Somewhere In Between?

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Emergency physicians have dynamic changes to their work-ups (particularly in the selection of imaging) related to how busy, not how long, a shift is.

Source
How are Patient Order and Shift Timing Associated With Imaging Choices in the Emergency Department? Evidence From Niagara Health Administrative Data. Ann Emerg Med. 2022 Aug 8;S0196-0644(22)00412-7. doi: 10.1016/j.annemergmed.2022.06.002. Online ahead of print.

How Accurate Is CT for Hollow Viscus Injury After GSW?

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Contrast enhanced CT can help predict the risk of hollow viscus injury after thoracoabdominal gunshot wounds. Specifically, there is low probability of hollow viscus injury in the absence of abdominal free fluid, focal gastrointestinal wall thickness, or fat stranding on CT.

Source
Diagnostic accuracy of computed tomography findings for hollow viscus injuries following thoracoabdominal gunshot wounds. J Trauma Acute Care Surg. 2022 Jul 15. doi: 10.1097/TA.0000000000003743. Online ahead of print.

POCUS – We Can…But Should We?

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POCUS in the ED can lead to clinically useful information, although research has not yet demonstrated patient-centered improvements in care. While this modality shouldn’t be used for routine screening in the ED, it performs well with a focused clinical question.

Sources
PoCUS: Just because we can doesn’t mean we should. Acad Emerg Med. 2022 Apr;29(4):515-517. doi: 10.1111/acem.14474. Epub 2022 Mar 22.
Risk-Benefit Analysis of PoCUS for Suspected, Ruptured Abdominal Aortic Aneurysm. Acad Emerg Med. 2022 Apr 14. doi: 10.1111/acem.14506. Online ahead of print.

Prevalence and Significance of Incidental Findings on CTPA

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Computed tomography pulmonary angiography (CTPA) yields an alternative diagnosis to pulmonary embolism (PE) in ~40% of patients with a negative PE study. Alternative diagnoses are more likely to occur in patients with increased age and in patients referred from the hospital setting (ICU or inpatient unit).

Source
Prevalence and significance of incidental findings on computed tomography pulmonary angiograms: A retrospective cohort study. Am J Emerg Med. 2022 Apr;54:232-237. doi: 10.1016/j.ajem.2022.01.064.

Clear as Mud – Is Your Management of Diverticulitis Evidence-Based?

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There are few studies that address the overall diagnosis and management of acute left sided colonic diverticulitis; many, over the past 3 decades, have poor strength of evidence or are largely inconclusive.

Source
Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis : A Systematic Review. Ann Intern Med. 2022 Mar;175(3):379-387. doi: 10.7326/M21-1645. Epub 2022 Jan 18.

Can You Spot a Ruptured AAA? Accuracy of Symptoms, Signs, CTA, and POCUS

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Symptoms and signs of ruptured abdominal aortic aneurysm (rAAA) are frustratingly insensitive. CTA is essential and is accurate. POCUS can accurately tell you a AAA is present but is not meant to diagnose rupture.

Source
Accuracy of Presenting Symptoms, Physical Examination, and Imaging for Diagnosis of Ruptured Abdominal Aortic Aneurysm -Systematic Review and Meta-Analysis. Acad Emerg Med. 2022 Feb 27. doi: 10.1111/acem.14475. Online ahead of print.

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