Old Person + Delirium = Head CT
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Among patients ≥65 years who presented to the ED with delirium, confusion, or altered mental status, 15.6% had an abnormal head CT. Presence of neurologic deficit was a significant predictor for abnormal CT, but anticoagulation was not.
Source
Head Computed Tomography Findings in Geriatric Emergency Department Patients with Delirium, Altered Mental Status, and Confusion: A Systematic Review. Acad Emerg Med. 2022 Nov 4. doi: 10.1111/acem.14622. Online ahead of print.
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.
Incidental Isn’t Inconsequential – How to Follow Up Incidental Findings on Radiographs
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A novel comprehensive methodized process is presented for the proper disclosure of incidental findings on ED imaging and for ensuring proper follow up and subsequent management.
Source
Catching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with Incidental Radiologic Findings. Ann Emerg Med. 2022 Sep;80(3):235-242. doi: 10.1016/j.annemergmed.2022.04.026. Epub 2022 Jun 23.
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.
Accuracy of Neuroimaging for Dizziness – It’s Not Pretty
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We cannot rely on neuroimaging (CT, CTA, MRI or MRA) alone to effectively rule out stroke in patients presenting to the ED with acute dizziness or vertigo.
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.
It’s Only a Flesh Wound! Selective Non-operative Management of Abdominal Stab Wounds
Source
Prospective Evaluation of the Selective Nonoperative Management of Abdominal Stab Wounds: When is it Safe to Discharge? J Trauma Acute Care Surg. 2022 Jul 5. doi: 10.1097/TA.0000000000003733. Epub 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.