Do preliminary interpretations (PI) of CT scans correlate with final interpretations (FI) in surgical patients (SP) with abdominal pain (AP) evaluated in the emergency department (ED)?

2003 ◽  
Vol 114 (2) ◽  
pp. 292 ◽  
Author(s):  
S. Eachempati ◽  
D. Bonville ◽  
C.C. Lubitz ◽  
L.J. Hydo ◽  
P.S. Barie
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Surgical Patients ◽  
Ct Scans

Quick Looks Into the Acute Abdomen- Findings from A 1 Year Audit of Asian Emergency Department Ct Scans

2021 ◽  
Author(s):  
Siang Hiong Goh ◽  
Calvin Yit-Kun Goh ◽  
Hong Choon Oh ◽  
Narayan Venkataraman ◽  
Ling Tiah
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Clinical Performance ◽  
Biliary Tract Disease ◽  
Renal Stones ◽  
Adverse Outcomes ◽  
Ct Scans ◽  
Lower Quadrant ◽  
Lengths Of Stay ◽  
The Common

Abstract BackgroundMuch of the literature regarding Emergency Department CT scan usage for abdominal pain has been in American and European settings, and less so in the rest of the world. We performed an audit for this in our Southeast Asian hospital to see how we compare with international data, also to glean some insights into optimising its use locally.Results – An anonymised de-identified electronic database of all ED patients had been set up since 2020 with the aim of capturing 10 years of ED retrospective data for audit of our clinical performance. From this master database, a subset of all CTAPs done in 2020 was created and then extracted for analysis. Costs, length of stay in the ED and wards, CT reports, disposal from ED, and other data were captured for study. A description was made of the common conditions found, with a subgroup analysis of the elderly, and disposal outcomes from the ED. Specific analysis was done for appendicitis using Mann-Whitney U tests. For 2020, 1860 patients (56% male, and ages 14 to 99 years) had ED CTAPs done. Top indications included right upper and lower quadrant pains, flank pains, persistent abdominal pain despite analgesia, and suspicion for intestinal obstruction. Acute appendicitis, biliary tract disease, renal stones, ovarian disease, and bowel disease were the common diagnoses. 16.2% of CTAPs revealed no abnormality. Malignancies were uncommon diagnoses. For the patients that were discharged from the ED after a negative CTAP, no patient returned within 72 hours nor were there any adverse outcomes. When analysed using Mann-Whitney U tests, patients who had ED CTAPs done for appendicitis had significantly faster time to CT and surgery than those with inpatient imaging, with lower inpatient costs and lengths of stay.Conclusion – CT scans in the ED for appendicitis patients reduces costs, time to surgery, and lengths of stay. Generally, ED CTAPs allows better siting and disposition of patients. Presence of RLQ pain increases the likelihood of a positive scan. Our negative scan rate of 16.2% is comparable to other studies. Protocols and senior inputs can improve accuracy of this important ED resource.

scholarly journals The Diagnostic Utility and Clinical Impact of After-Hours CT Scans of the Abdomen and Pelvis Investigating Abdominal Pain

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Monil Karia ◽  
Matthew Seager ◽  
Akkib Rafique ◽  
Hemant Sheth
Keyword(s):  
Abdominal Pain ◽  
Clinical Outcomes ◽  
Clinical Management ◽  
Ct Scanning ◽  
Surgical Patients ◽  
Ct Scans ◽  
Diagnostic Utility ◽  
Histopathological Findings ◽  
Clinical Notes ◽  
After Hours

Introduction.The aim of this study was to evaluate the diagnostic utility and impact on clinical management of after-hours CT scans investigating abdominal pain in surgical patients.Methods.After-hours CT A/P reports investigating the acute surgical abdomen were compared with clinical outcomes and histopathological findings to assess sensitivity and specificity of CT reporting. Comparisons between CT reports and clinical notes were made. CT scans were categorised as having direct effects on clinical management, ruling out a serious pathology, ruling out a nonserious pathology, or having no effect. Discrepancies between information in case-notes and information provided to radiologists were also analysed.Results.79 clinical notes were located. After-hours CT demonstrated 91% sensitivity and 82% reporting specificity using clinical outcomes as the standard. In the 26 patients with histopathological findings, CT reports demonstrated 91% sensitivity. In 79.7% of cases, CT scanning had an impact on management. In 35.4% of cases, an indication for scanning was not documented with variation in clinical information in 8.9% of cases.Discussion.This study demonstrates after-hours CT A/P reports result in significant impacts on clinical management of surgical patients with acute abdominal pain. Improvements in providing information when requesting scans are however needed to facilitate accurate reporting.

EP.FRI.943 Time to surgical review in NELA patients

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Laura Kenny ◽  
Ahmed Waqas ◽  
Elizabeth Hall
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Royal College ◽  
Small Sample Size ◽  
Surgical Care ◽  
Small Sample ◽  
Surgical Patients ◽  
Emergency Laparotomy ◽  
Pain Pathway ◽  
National Emergency

Abstract Introduction The Royal College of Surgeons standards on unscheduled surgical care state that an ST3 or above should review emergency cases within 60 minutes of referral from the Emergency Department (ED). Method Data was gathered from all admissions (n = 50), from 01/9/19 to 31/10/19, registered on the National Emergency Laparotomy Audit (NELA).  After exclusions, there were 20 patients who were admitted to surgery from ED.  14 of these had both time of referral and time of review documented. Results On average, patients were reviewed 2 hours and 23 minutes after referral.  9 of these patients (64%) were referred overnight (20:00-08:00) and their average time to review was longer; 2 hours and 49 minutes. 7 of all 50 NELA patients (14%) were never referred to surgery from ED. Conclusion Limitations include that ED doctors did not document what time patients were referred to surgery, and a small sample size; partially due to poor documentation. The recommended 60 minutes time to registrar review is not being achieved but data is limited. To improve this, surgical registrars will be asked to document time of referral. Data on time to review will continue to be gathered. An abdominal pain pathway will be introduced to improve ED’s recognition of surgical patients. A re-audit which will encompass patients admitted via ED and ambulatory care, as well as including data on time to decision to operate is currently underway.

scholarly journals TP9.2.17Developing Novel Referral Pathways in Emergency Surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Victoria Morrison-Jones ◽  
Katherine Pearson ◽  
Ian Bailey ◽  
Vasileios Trompetas ◽  
David Berry
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Young Women ◽  
Surgical Patients ◽  
Admission Criteria ◽  
Missed Opportunities ◽  
Direct Admission ◽  
Pregnancy Status ◽  
Protocol Compliance ◽  
Surgical Unit

Abstract Introduction In line with the principles of GIRFT and recognising the demand on the Emergency Department (ED) the Acute Surgical Unit (ASU) developed a direct admission pathway entitled ‘ASU Direct’ (ASUD). Nurse led ED triage with adherence to a referral proforma allows direct admission of suitable surgical patients eliminating medical ED review or discussion with the on-call Registrar. Aim Investigate the usefulness of the ASUD pathway and adherence to admission criteria. Method Two retrospective audits of ASUD referrals were completed and compared with concurrent traditional registrar referrals. Inter-departmental discussions occurred between audit cycles. Results Audit 1: 13 days, 150 cases (8 excluded). 75 (53%) referred via ASUD, 67 (47%) via surgical registrar. Sixteen ASUD cases (22%) breached pathway protocols including 3 young women referred without pregnancy tests. Seventeen (25%) cases referred via the Registrar fulfilled ASUD criteria. Documentation complete in 56% of ASUD cases. Audit 2: (3 weeks after feedback) - 10 days, 120 patients (25 excluded). Fifty one ASUD cases (54%) and 44 (46%) registrar referrals. 24% cases breached ASUD criteria, 7 registrar referrals (15%) appropriate for ASUD. ASUD documentation completed in 60% with 100% pregnancy status recorded. Conclusions Proportion of ASUD / registrar referrals remained constant but there were fewer missed opportunities for ASUD. Inappropriate ASUD admissions remained similar. While ASUD worked well for visible pathology, less-so for protocol-driven abdominal pain. Senior ‘front-door’ triage in ED might improve protocol compliance, helping to develop such pathways, observing GIRFT and avoid unnecessary transfer of patients (especially during the COVID pandemic).

Bedside ultrasound in the emergency department and abdominal pain

2016 ◽  
Vol 37 (S 01) ◽  
Author(s):  
M Algaba Montes ◽  
AÁ Oviedo García ◽  
M Patricio Bordomás
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Bedside Ultrasound

A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

2020 ◽  
pp. 1-3
Author(s):  
Jinping Xu ◽  
Jinping Xu ◽  
Ruth Wei ◽  
Salieha Zaheer
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Femoral Hernia ◽  
Rare Case ◽  
Hernia Recurrence ◽  
High Morbidity ◽  
Diagnostic Challenge ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
History Of

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

scholarly journals Lactobacillus Reuteri DSM 17938 (Limosilactobacillus reuteri) in Diarrhea and Constipation: Two Sides of the Same Coin?

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 643
Author(s):  
Angela Saviano ◽  
Mattia Brigida ◽  
Alessio Migneco ◽  
Gayani Gunawardena ◽  
Christian Zanza ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Human Health ◽  
Bowel Disease ◽  
Chronic Constipation ◽  
Lactobacillus Reuteri ◽  
Current Knowledge ◽  
Gastrointestinal Symptoms ◽  
Inflammatory Bowel

Background and Objectives: Lactobacillus reuteri DSM 17938 (L. reuteri) is a probiotic that can colonize different human body sites, including primarily the gastrointestinal tract, but also the urinary tract, the skin, and breast milk. Literature data showed that the administration of L. reuteri can be beneficial to human health. The aim of this review was to summarize current knowledge on the role of L. reuteri in the management of gastrointestinal symptoms, abdominal pain, diarrhea and constipation, both in adults and children, which are frequent reasons for admission to the emergency department (ED), in order to promote the best selection of probiotic type in the treatment of these uncomfortable and common symptoms. Materials and Methods: We searched articles on PubMed® from January 2011 to January 2021. Results: Numerous clinical studies suggested that L. reuteri may be helpful in modulating gut microbiota, eliminating infections, and attenuating the gastrointestinal symptoms of enteric colitis, antibiotic-associated diarrhea (also related to the treatment of Helicobacter pylori (HP) infection), irritable bowel syndrome, inflammatory bowel disease, and chronic constipation. In both children and in adults, L. reuteri shortens the duration of acute infectious diarrhea and improves abdominal pain in patients with colitis or inflammatory bowel disease. It can ameliorate dyspepsia and symptoms of gastritis in patients with HP infection. Moreover, it improves gut motility and chronic constipation. Conclusion: Currently, probiotics are widely used to prevent and treat numerous gastrointestinal disorders. In our opinion, L. reuteri meets all the requirements to be considered a safe, well-tolerated, and efficacious probiotic that is able to contribute to the beneficial effects on gut-human health, preventing and treating many gastrointestinal symptoms, and speeding up the recovery and discharge of patients accessing the emergency department.

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