scholarly journals Reporting Discrepancy Resolved by Findings and Time in 2947 Emergency Department Ankle X-rays

2019 ◽  
Vol 49 (4) ◽  
pp. 601-611 ◽  
Author(s):  
Thomas James York ◽  
P. J. Jenkins ◽  
A. J. Ireland
Keyword(s):  
Emergency Department ◽  
Working Hours ◽  
High Standard ◽  
Causative Factor ◽  
X Rays ◽  
Type B ◽  
Complete Dataset ◽  
Specific Finding ◽  
Weber Type ◽  
Major Discrepancy

Abstract Aims To identify common errors in ankle X-ray reporting between initial interpretation and final assessment at the virtual fracture clinic. Also, to assess time of initial reporting as a causative factor for discrepancy. Methods Two thousand nine hundred forty-seven final reports were reviewed by standard of agreement to the initial interpretation. Where discrepancy was found, it was classified and collated by specific finding. Comparison was made between reports with discrepancy and the complete dataset, allowing rates of error by finding to be established. The reports containing discrepancy were further classified by time period, this was compared against an expected value to establish if initial reporting outside of routine working hours was as accurate as that conducted within routine working hours. Results 94.4% of reports were in agreement with the initial interpretation, 2.9% contained minor discrepancy, and 2.7% major discrepancy. In 45.6% of reports there was no radiologically observable injury. 16.4% of reports contained a lateral malleolar fracture, most commonly Weber type B. 40.0% of all navicular fractures, and 33.3% of all cuboidal fractures were not commented upon in the initial reporting. Lower rates of more frequently observed findings were missed with 2.5% of Weber type B fractures not commented upon. An increased proportion of major discrepancy reports were generated from 00:00 to 07:59 (expected = 15.0%, observed = 22.2%; p = 0.07908). Similarly, a greater than expected number of minor discrepancy reports were found between 20:00 and 23:59 (expected = 18.0%, observed = 34.1%, p = 0.00025). Conclusions The initial reporting of ankle X-rays in the emergency department is performed to a high standard, however serious missed findings emphasise the need for timely senior review. Reporters should increase their awareness of navicular, cuboid, talar, and Weber A fractures which were missed at disproportionate rates. This study also finds evidence to support increased rates of error in initial reporting of ankle X-rays outside of normal working hours (17:00–07:59), particularly with a significantly increased rate of minor discrepancy seen from 20:00 to 23:59.

scholarly journals A Retrospective Review of Patients with Radiological Missed Fractures in an Emergency Department in Hong Kong

2003 ◽  
Vol 10 (4) ◽  
pp. 215-222 ◽  
Author(s):  
VCH Ng ◽  
FL Lau
Keyword(s):  
Emergency Department ◽  
Management Plan ◽  
Lower Limbs ◽  
X Rays ◽  
Accident And Emergency ◽  
Assessment And Treatment ◽  
Spinal Region ◽  
Accident And Emergency Department ◽  
Clinical Records ◽  
Christian Hospital

Aim To review the clinical spectrum and outcome of radiological missed fractures in the Accident and Emergency Department of United Christian Hospital (UCH) in 2002. Method In UCH, radiologists report all X-Rays taken in the Accident and Emergency Department (AED) within 48 hours. The study period was from 1st January 2002 to 31st December 2002. AED notes, relevant clinical records and all X-rays of patients with suspected missed fractures as reported by radiologists were reviewed for information on clinical features, treatments and outcomes. Results A total of 286 cases of missed fractures were found. Fourteen (4.9%) involved the skull and maxillofacial region, 83 (29.0%) involved the chest region, 53 (18.5%) involved the spinal region, 72 (25.2%) involved the upper limbs and 64 (22.4%) involved the lower limbs. Of these 286 cases, 137 (47.9%) were followed up in AED, 90 (31.5%) were referred to specialist clinics for further management, 26 (9.1%) required admission to hospital for further assessment and treatment, and 33 (11.5%) defaulted follow up. Furthermore, 87 (30.4%) of these 286 missed fractures required a change in management plan: 3 missed fractures required operative intervention (internal fixation) and 84 missed fractures required some form of external immobilisation. This group of patient did not lodge any complaint or claim. Conclusion A&E doctors missed quite a number of fractures that might result in significant morbidity. However, a reporting system by radiologists within 48 hours from discharge can pick up all these missed fractures, and may prevent complaints and litigations.

LESSONS FROM THE FIRST COVID WAVE AND STRAIN - A STUDY OF PSYCHIATRIC DISORDERS IN THE PANDEMIC - FACTORS ASSOCIATED AND PREVENTIVE STRATEGIES

2021 ◽  
pp. 22-28
Author(s):  
Ojas Unavane ◽  
Karishma Rupani ◽  
Kajal Makwana ◽  
Shilpa Adarkar ◽  
Upali Anand
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Past History ◽  
Psychiatric Morbidity ◽  
Working Hours ◽  
Causative Factor ◽  
Lessons Learned ◽  
Daily Routine ◽  
Snowball Sampling ◽  
Factors Associated

Background: The COVID-19 pandemic has affected people worldwide. Desperate times (SARS COV-2 being a novel virus) called in for desperate measures in that right from its containment strategies to failed treatment trials have had various ramications affecting various spheres of our lives. It has already been established that the pandemic has taken a toll on mental health, cutting across all strata of society. However, apart from the pandemic in it itself as a causative factor, there are various other factors contributing to the increase in the mental health burden; some of which are modiable. An in-depth understanding of these modiable risk factors is the need of the hour, so that policies and guidelines can be framed accordingly to salvage what can be; of the mental health of the population at large. Understanding these modiable risk factors are lessons learned which will help us mitigate the mental health morbidity during the subsequent waves of the Pandemic. Aim: To study the prevalence and factors associated with the psychiatric morbidity in the general population during the COVID - 19 pandemic. Methods: The data was collected by snowball sampling using an online form to collect the demographic and clinical variables with the DASS - 21 scale appended. Conclusion: The prevalence of depression and anxiety was found to be 25.3 % and 26.2 % respectively. The signicant factors associated with psychiatric morbidity ranged across the psychological biological and social domains, some non-modiable whilst others modiable risk factors. The modiable factors identied were substance use, past history of psychiatric illness, chronic physical illness, increased screen time use, watching news (online) about the pandemic, working hours, disruption of a daily routine and a change in the lifestyle of people

What a Pain in the Neck!

2020 ◽  
pp. 13-22
Author(s):  
Walter Wiswell ◽  
Bryan McCarty
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Cervical Spine ◽  
Neck Pain ◽  
Pediatric Patient ◽  
Ct Scans ◽  
X Rays ◽  
Pros And Cons ◽  
Current Guidelines ◽  
Patient Presentation

The chapter on cervical spine controversies in children describes what initial steps need to be taken in assessing a pediatric patient with neck pain after trauma, and discusses the decision-making process that goes into further evaluation and testing. Clinical actions and assessments of the patient on-scene, whether to pursue imaging once in the emergency department setting, and what imaging is most appropriate depending on the patient presentation are discussed. Indications and contraindications for cervical spine immobilization and spinal positioning, including proper techniques based on a patient’s age and whether or not such steps are necessary. It also discusses the pros and cons of x-rays, CT scans, and MRIs in the context of pediatric neck trauma, and current guidelines that should be followed when deciding to order such studies.

scholarly journals Postsurgical residual lung complications following left upper trisegmentectomy

2019 ◽  
Author(s):  
Yutaro Koike ◽  
Aritoshi Hattori ◽  
Takeshi Matsunaga ◽  
Kazuya Takamochi ◽  
Shiaki Oh ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Type A ◽  
X Rays ◽  
Limited Information ◽  
Type B ◽  
Type D ◽  
Thoracic Computed Tomography ◽  
Isolated Segment ◽  
Type C ◽  
Lung Torsion

AbstractOBJECTIVESSegmentectomy has become an increasingly popular surgical procedure for small-sized lung lesions. Left upper trisegmentectomy (LUTS) is one of the most common segmentectomies performed because of its relative ease and simplicity; however, limited information is currently available on the specific postoperative complications associated with this procedure.METHODSAmong 2060 surgically resected cases in our institute between 2009 and 2016, 129 (6.2%) underwent LUTS. Postoperative chest X-rays and/or thoracic computed tomography (CT) scans were retrospectively assessed for all cases to assess postsurgical residual lung complications following LUTS. We categorized cases into 4 groups: type A (atelectasis of the lingular segment), type B (lung torsion of the lingular segment), type C (necrosis of the ‘isolated segment’) and type D (haematoma along stapling lines).RESULTSPostsurgical lung complications following LUTS were observed in 17 (13.1%) patients (type A: n = 7, type B: n = 1, type C: n = 4 and type D: n = 5). Three patients (2.3%) required surgical intervention because of type B (n = 1) and type C (n = 2), namely, decreased permeability and remaining ground glass opacities in the residual lung, showing an exacerbated systemic inflammatory response. In contrast, type A and D cases were successfully observed by chest CT without any surgical intervention, and patients recovered within a few months of surgery.CONCLUSIONSWe identified several postoperative residual lung complications following LUTS. Lung torsion or necrosis of the residual segment may require intensive care, including reoperation. Potentially serious complications always need to be ruled out after LUTS when radiological consolidation is detected postoperatively.

scholarly journals Detection of Type B Aortic Dissection in the Emergency Department with Point-of-Care Ultrasound

2019 ◽  
Vol 3 (3) ◽  
pp. 202-207 ◽  
Author(s):  
Emily Earl-Royal ◽  
Phi Nguyen ◽  
Al’ai Alvarez ◽  
Laleh Gharahbaghian
Keyword(s):  
Emergency Department ◽  
Aortic Dissection ◽  
Point Of Care ◽  
Case Reports ◽  
Point Of Care Ultrasound ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Diagnostic Reliability ◽  
Multiple Case ◽  
Stanford Type B

Aortic dissection (AD) is a rare, time-sensitive, and potentially fatal condition that can present with subtle signs requiring timely diagnosis and intervention. Although definitive diagnosis is most accurately made through computed tomography angiography, this can be a time-consuming study and the patient may be unstable, thus preventing the study’s completion. Chest radiography (CXR) signs of AD are classically taught yet have poor diagnostic reliability. Point-of-care ultrasound (POCUS) is increasingly used by emergency physicians for the rapid diagnosis of emergent conditions, with multiple case reports illustrating the sonographic signs of AD. We present a case of Stanford type B AD diagnosed by POCUS in the emergency department in a patient with vague symptoms, normal CXR, and without aorta dilation. A subsequent review of CXR versus sonographic signs of AD is described.

scholarly journals The Fakir Child: Clinical Observation or Invasive Treatment?

2020 ◽  
Vol 12 (3) ◽  
pp. 103-107
Author(s):  
Antonio Gatto ◽  
Serenella Angelici ◽  
Claudia Di Pangrazio ◽  
Lorenzo Nanni ◽  
Danilo Buonsenso ◽  
...  
Keyword(s):  
Emergency Department ◽  
Foreign Bodies ◽  
Case Reports ◽  
Pediatric Population ◽  
Case Series ◽  
Expectant Management ◽  
X Rays ◽  
Gi Tract ◽  
Invasive Treatment ◽  
Foreign Objects

Accidental swallowing of foreign bodies is a common problem among the pediatric population (6 months to 3 years), especially if the foreign body (FB) presents a sharp end that could potentially lead to perforation of the gastrointestinal (GI) tract, resulting in infection and complications. We report the case of a 2-year-old, admitted to the Emergency Department of our hospital after ingesting two FBs classifiable as sharp objects, specifically two metal nails, both approximately 4-cm long, which had been swallowed in one go, as reported by the parents. The patient had been previously admitted to another hospital in the same region, where the Emergency Department (ED) doctors took an X-ray to confirm the ingestion. The foreign bodies ingestion was thus confirmed, and they were, according to their report, located in the GI tract over the stomach. The patient has been monitored through all of his stay in the hospital and the progression of the foreign bodies has been documented with serial X-rays. Since neither clinical nor radiological signs of perforation were present, putting the FBs in the small bowel, a non-operative expectant management was followed. After 4 days of admission, the patient had passed one of the two FBS and later on the second one, without any complication. Thereafter the patient was discharged. The management of sharp gastrointestinal foreign objects ingestion is still debated, and the data of the current literature are poor. A number of case reports and small case series describe successful conservative management for the majority of ingested sharp objects. According to the literature data, our report confirms that the ingestion of sharp objects and relatively big objects in a baby can be successfully non-operatively managed, even despite the age of the patient and though the FBs are multiple.

scholarly journals P016: Low risk ankle rule, high reward-a quality improvement initiative to reduce ankle x-rays in the pediatric emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S83 ◽  
Author(s):  
F. Al-Sani ◽  
M. Ben-Yakov ◽  
G. Harvey ◽  
J. Gantz ◽  
D. Jacobson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Ankle Injuries ◽  
Pediatric Emergency Department ◽  
X Rays ◽  
X Ray ◽  
Return Visits ◽  
Unnecessary Testing

Introduction: Our tertiary care institution embarked on the Choosing Wisely campaign to reduce unnecessary testing, and selected the reduction of ankle x-rays as part of its top five priority initiatives. The Low Risk Ankle Rule (LRAR), an evidence-based decision rule, has been derived and validated to clinically evaluate ankle injuries which do not require radiography. The LRAR, is cost-effective, has 100% sensitivity for clinically important ankle injuries and reduces ankle imaging rates by 30-60% in both academic and community setting. Our objective was to significantly reduce the proportion of ankle x-rays ordered for acute ankle injuries presenting to our pediatric Emergency Department (ED). Methods: Medical records were reviewed for all patients presenting to our tertiary care pediatric ED (ages 3- 18 years) with an isolated acute ankle injury from Jan 1, 2016-Sept 30, 2016. Children with outside imaging, an injury that occurred >72 hours prior, or those who had a repeat ED visit for same injury were excluded. Quality improvement (QI) initiatives included multidisciplinary staff education about the LRAR, posters placed within the ED highlighting the LRAR, development of a new diagnostic imaging requisition for ankle x-rays requiring use of the LRAR and collaboration with the Division of Radiology to ensure compliance with new requisition. The proportion of patients presenting to the ED with acute ankle injuries who received x-rays was measured. ED length of stay (LOS), return visits to the ED and orthopedic referrals were collected as balancing measures. Results: At baseline 88% of patients with acute ankle injuries received x-rays. Following our multiple interventions, the proportion of x-rays decreased significantly to 54%, (p<0.001). This decrease in x-ray rate was not associated with an increase in ED LOS, ED return visits or orthopedic referrals. There was an increase uptake of the dedicated x-ray requisition over time to 71%. Conclusion: This QI initiative to increase uptake of the LRAR, resulted in a significant reduction of ankle x-rays rates for children presenting with acute ankle injuries in our pediatric ED without increasing LOS, return visits or need for orthopedic referrals for missed injuries. Just as in the derivation and validation studies, the reductions have been sustained and reduced unnecessary testing and ionizing radiation.

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