scholarly journals LO26: Reduction of CT scan use in emergency department patients with recurrent renal colic

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S15-S16
Author(s):  
D. M. Shelton ◽  
F. Berger
Keyword(s):  
Ct Scan ◽  
Kidney Stones ◽  
Renal Colic ◽  
Imaging Modality ◽  
Fold Increase ◽  
Renal Stones ◽  
Ct Scans ◽  
Emergency Physicians ◽  
Safe Alternative ◽  
History Of

Introduction: CT scan is the most common imaging modality for suspected renal colic and is used for about 80% of presentations. Cumulative ionizing radiation exposure from repeat CT scans increases long-term cancer risk. Despite a 10-fold increase in CT use to detect kidney stones in the ED in just over a decade, there has been no increase in the proportion of kidney stones diagnosed, number of significant alternate diagnoses or admissions to hospital. Choosing Wisely recommends to avoid ordering CT of the abdomen/pelvis in otherwise healthy patients<age 50 presenting to the ED with known history of kidney stones and with symptoms consistent with uncomplicated renal colic. The aim is that >90% of patients < age 50 with a history of renal stones arriving in Sunnybrook ED with symptoms consistent with renal colic will be managed without a CT abdomen/pelvis. Methods: Emergency physicians were engaged in the process at various stages, including a brainstorming session to perform a root cause analysis. A Driver diagram was created to generate change ideas. Outcome Measure Number of CT scans ordered for target population (Results: Results to date indicate that there is a non-sustained decrease in the number of CT scans performed on ED patients < age 50 with recurrent renal colic. The STONE score was infrequently used, thus making it difficult to standardize CT ordering for presumed renal colic. Conclusion: As a result of this QI initiative, there is awareness amongst emergency physicians of a patient population that is over imaged with CT scan, often with no change in management. Introduction of a low dose CT scan order was the greatest gain from this QI initiative. In order to decrease CT utilization, physicians need to be shown the lack of benefit of CT use and a safe alternative diagnostic approach.

EP.FRI.390 Improving care for patients with acute bowel obstruction: A closed loop audit

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Benjamin Clayphan ◽  
Anna Fairclough ◽  
Jeff Lim ◽  
Roderick Alexander
Keyword(s):  
Ct Scan ◽  
Patient Outcomes ◽  
Bowel Obstruction ◽  
Care Pathway ◽  
Imaging Modality ◽  
Ct Scans ◽  
Abdominal Ct ◽  
Retrospective Audit ◽  
Raising Awareness ◽  
Time To Diagnosis

Abstract Aims Acute Bowel Obstruction (ABO) accounts for 10% of emergency surgical admissions and when surgery is required mortality can exceed 10%. Early diagnosis is associated with improved patient outcomes and timely acquisition of abdominal CT scans can help prevent delays. The NCEPOD 2020 report on ABO identified ‘delays in imaging’ as a key area for improvement in the care of these patients, with these delays being exacerbated if an abdominal X-ray (AXR) was performed as well as an abdominal CT. This study looks at ways to expedite the diagnosis of patients presenting with ABO.   Methods A retrospective audit of 77 patients admitted from A&E or SAU with ABO from April 2019 to February 2020 was conducted. Imaging modality, time-to-CT scan and time-to-diagnosis was recorded. Results and recommendations were presented locally and an evidence based ABO care pathway was implemented and publicised. 20 patients were audited prospectively, post care pathway implementation.  Results 70.1% of patients from the initial audit received a CT-scan and 42% of these patients received an AXR before their eventual CT-scan. The average wait for a definitive radiological diagnosis was 27.8hr. After implementation of the pathway only 18% of patients audited received both modes of imaging and the average time to diagnosis has been reduced to 10.7hr.  Conclusions Raising awareness of the appropriate and timely use of CT-scans in the diagnosis of ABO has reduced the number of concomitant AXR for these patients, expediting the making of a definitive diagnosis and improving patient outcomes. 

scholarly journals Contrast versus non-contrast CT in urinary tract calculi

2018 ◽  
Vol 5 (3) ◽  
pp. 818
Author(s):  
Sofyan Faidah ◽  
Alyaa Banjar ◽  
Jaber Zarbah ◽  
Sarah Alfaer ◽  
Mohammed Alshulayyil ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Ct Scan ◽  
Imaging Modality ◽  
Urinary Calculi ◽  
Flank Pain ◽  
Ct Scans ◽  
Advantages And Disadvantages ◽  
Urinary Tract Calculi ◽  
Diagnostic Modalities ◽  
Contrast Ct

The incidence and prevalence of urinary tract calculi has increased significantly during the past decade. Accurate fast diagnostic modalities were developed to cope with such an increased trend. To date, non-contrast CT scan remains the diagnostic modality of choice for evaluation of patients with urinary tract calculi. However, contrast CT scans are gaining more interest. In this review, both diagnostic modalities were reviewed with the advantages and disadvantages of each. Non-contrast CT scan is a rapid, accurate, less hazardous, less expensive imaging modality that has a high sensitivity in detection of urinary calculi as small as 3 mm. However, it cannot evaluate other probable causes of flank pain. Thus, contrast CT scans can be used in situations where clinical presentation is suspicious and the possibility of other differential diagnoses is considered. Contrast CT scans do not decrease the sensitivity of detecting urinary calculi, and they do have a higher sensitivity in detecting small grades of obstruction as well as evaluating other possible causes of flank pain such as neoplasms, infectious, or inflammatory aetiologies. 

scholarly journals Incidence and Risk Factors for Bilateral Nephrolithiasis: A Large Case-retrospective Study

2021 ◽  
Author(s):  
Xiong Yang ◽  
Zhi Li ◽  
Shiyong Qi ◽  
Linguo Xie ◽  
Qiduo Shi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Multivariate Analysis ◽  
Kidney Stones ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Renal Stones ◽  
Urinary Stones ◽  
Preoperative Imaging ◽  
History Of

Abstract To determine the incidence and risk factors of bilateral kidney stones. Utilized the retrospective analysis method on demographic characteristics and clinical data of patients with renal stones in the Second Hospital of Tianjin Medical University. Grouped patients into unilateral and bilateral renal stones according to preoperative imaging and ultrasound examination. Univariate and multivariate analysis methods were used to evaluate the factors that may cause bilateral stones. The study included 7587 patients with kidney stones in total, of whom 4983 had unilateral kidney stones (including 2719 left stones and 2264 right stones), and 2604 had bilateral kidney stones (34.3%). By comparing the unilateral stones group with the bilateral stones group, the univariate analysis demonstrated that weight, body mass index (BMI), history of nephrolithiasis, diabetes mellitus (DM), hypertension, gout, and the maximal stone diameter had statistical significance. Binary logistic regression multivariate analysis demonstrated that BMI, history of nephrolithiasis, diabetes mellitus, hypertension, gout, and the maximal stone diameter were independent risk factors for bilateral urinary stones. This study shows that 34.3% of patients with kidney stones were diagnosed as having bilateral kidney stones; BMI and the maximal stone diameter are positively correlated with the incidence of bilateral kidney stones; Patients with a history of nephrolithiasis, diabetes, hypertension, and gout have a significantly higher risk of having bilateral kidney stones.

History of CT Scan Studies in Aphasia—1970s to 1990s

2018 ◽  
Author(s):  
Margaret A. Naesser ◽  
Carole L. Palumbo ◽  
Paula I. Martin
Keyword(s):  
Ct Scan ◽  
Medical Center ◽  
Veterans Affairs ◽  
Hemispheric Dominance ◽  
Ct Scans ◽  
Lesion Site ◽  
Language Therapy ◽  
Boston University ◽  
History Of ◽  
Language Areas

This chapter summarizes early computed tomography (CT) scan studies in stroke patients with aphasia from the 1970s through the 1990s. Studies took place at the Boston University Aphasia Research Center located at the Boston Veterans Affairs Medical Center. Earliest studies associated classical aphasia syndromes with lesions located in cortical language areas on CT scans. In the 1980s, studies reported that chronic aphasia could be associated with subcortical lesion only; emphasis was on lesion in white matter pathways. In the 1990s, studies showed that lesion sites on CT scans performed after 2 months poststroke could be predictive for recovery of auditory language comprehension, and meaningful nonfluent speech at 1 year poststroke. Lesion site patterns were identified for different outcome levels following specific language therapy programs. Some rare aphasia cases are included: left-handers with separate hemispheric dominance locations for speech versus comprehension in the same person; and a unilateral, word deafness case.

scholarly journals A Case of Recurrent Renal Aluminum Hydroxide Stone

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Basri Cakıroglu ◽  
Akif Nuri Dogan ◽  
Tuncay Tas ◽  
Ramazan Gozukucuk ◽  
Bekir Sami Uyanik
Keyword(s):  
Aluminum Hydroxide ◽  
Kidney Stones ◽  
Renal Stone ◽  
Renal Colic ◽  
Case Reports ◽  
Geographic Location ◽  
Stone Disease ◽  
Common Type ◽  
History Of ◽  
Ca Oxalate

Renal stone disease is characterized by the differences depending on the age, gender, and the geographic location of the patients. Seventy-five percent of the renal stone components is the calcium (Ca). The most common type of the stones is the Ca oxalate stones, while Ca phosphate, uric acid, struvite, and sistine stones are more rarely reported. Other than these types, triamterene, adenosine, silica, indinavir, and ephedrine stones are also reported in the literature as case reports. However, to the best of our knowledge, aluminum hydroxide stones was not reported reported before. Herein we will report a 38-years-old woman with the history of recurrent renal colic disease whose renal stone was determined as aluminum hydroxide stone in type. Aluminum mineral may be considered in the formation of kidney stones as it is widely used in the field of healthcare and cosmetics.

scholarly journals The utility of renal ultrasonography in the diagnosis of renal colic in emergency department patients

CJEM ◽  
2010 ◽  
Vol 12 (03) ◽  
pp. 201-206 ◽  
Author(s):  
Marcia L. Edmonds ◽  
Justin W. Yan ◽  
Robert J. Sedran ◽  
Shelley L. McLeod ◽  
Karl D. Theakston
Keyword(s):  
Emergency Department ◽  
Radiation Exposure ◽  
Renal Colic ◽  
Imaging Modality ◽  
Data Extraction ◽  
Renal Stones ◽  
Ureteric Stone ◽  
Emergency Department Patients ◽  
Record Review ◽  
Retrospective Medical Record Review

ABSTRACT Objective: Computed tomography (CT) is an imaging modality used to detect renal stones. However, there is concern about the lifetime cumulative radiation exposure attributed to CT. Ultrasonography (US) has been used to diagnose urolithiasis, thereby avoiding radiation exposure. The objective of this study was to determine the ability of US to identify renal colic patients with a low risk of requiring urologic intervention within 90 days of their initial emergency department (ED) visit. Methods: We completed a retrospective medical record review for all adult patients who underwent ED-ordered renal US for suspected urolithiasis over a 1-year period. Independent, double data extraction was performed for all imaging reports and US results were categorized as “normal,” “suggestive of ureterolithiasis,” “ureteric stone seen” or “disease unrelated to urolithiasis.” Charts were reviewed to determine how many patients underwent subsequent CT and urologic intervention. Results: Of the 817 renal US procedures ordered for suspected urolithiasis during the study period, the results of 352 (43.2%) were classified as normal, and only 2 (0.6%) of these patients required urologic intervention. The results of 177 (21.7%) renal US procedures were suggestive of ureterolithiasis. Of these, 12 (6.8%) patients required urologic intervention. Of the 241 (29.5%) patients who had a ureteric stone seen on US, 15 (6.2%) required urologic intervention. The rate of urologic intervention was significantly lower in those with normal results on US (p &lt; 0.001) than in those with abnormal results on US. Conclusion: A normal result on renal US predicts a low likelihood for urologic intervention within 90 days for adult ED patients with suspected urolithiasis.

scholarly journals Measurement of Tibial Tuberosity–Trochlear Groove Offset Distance by Weightbearing Cone-Beam Computed Tomography Scan

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773415 ◽  
Author(s):  
John M. Marzo ◽  
Melissa A. Kluczynski ◽  
Anthony Notino ◽  
Leslie J. Bisson
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Cone Beam Ct ◽  
Ct Scans ◽  
Cone Beam ◽  
Trochlear Groove ◽  
Intrarater Reliability ◽  
Offset Distance ◽  
History Of ◽  
Conventional Ct

Background: Computed tomography (CT) scans are useful for objectively measuring bone alignment because they show bone detail particularly well, and these scans have been used extensively to assess patellar orientation. The tibial tubercle–trochlear groove (TT-TG) offset distance has been shown to be influenced by knee flexion and weightbearing, yet conventional CT scans are obtained with the subject relaxed, supine, and with the knee in full extension. A new cone-beam CT scanner has been designed to allow for weightbearing images, potentially providing a more physiologically relevant assessment of patellofemoral alignment. Purpose/Hypothesis: The purpose of this study was to measure the TT-TG offset in healthy individuals without any history of knee complaints when CT scans were obtained while fully weightbearing on a flexed knee. Our hypothesis was that the TT-TG offset measurement in these healthy knees would be reproducible and less than the historically reported normal range. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Twenty healthy volunteers without any history of knee complaint were recruited to undergo a weightbearing cone-beam CT scan of the knee flexed at 30°. The scans were reviewed by a radiologist and an orthopaedic surgeon, and TT-TG offset was measured using the digital tools of a picture archiving and communication system. Paired t tests were used to compare TT-TG offset on 2 separate occasions for both raters. Inter- and intrarater reliability were assessed using a 2-way mixed-effects model intraclass correlation coefficient with corresponding 95% confidence intervals for TT-TG offset. Results: The mean TT-TG offset was 2.7 mm. There were no statistically significant differences in TT-TG offset between raters ( Prater1 = .70; Prater2 = .49) and time of read ( Ptime1 = .83; Ptime2 = .19). Good to moderate interrater reliability was found at the time of both reads, and good intrarater reliability was found for both raters. Conclusion: When measured by CT scan and obtained from a subject while weightbearing on a flexed knee, the TT-TG offset is reproducible and the distance is less than that obtained via a conventional CT scan.

scholarly journals Yield of Emergent CT in Patients With Epilepsy Presenting With a Seizure

2018 ◽  
Vol 9 (2) ◽  
pp. 71-78 ◽  
Author(s):  
Kathryn A. Kvam ◽  
Vanja C. Douglas ◽  
William D. Whetstone ◽  
S. Andrew Josephson ◽  
John P. Betjemann
Keyword(s):  
Brain Tumor ◽  
Ct Scan ◽  
Head Trauma ◽  
Statistical Significance ◽  
Ct Scans ◽  
Medical Centers ◽  
Academic Medical ◽  
Breakthrough Seizure ◽  
History Of ◽  
Patients With Epilepsy

Background: Studies of emergent neuroimaging in the management of patients presenting with a breakthrough seizure are lacking. We sought to determine how often emergent computed tomography (CT) scans are obtained in patients with known epilepsy presenting with a seizure and how often acute abnormalities are found. Methods: This multicenter retrospective cohort study was performed in the emergency department at 2 academic medical centers. The primary outcomes were percentage of visits where a CT scan was obtained, whether CT findings represented acute abnormalities, and whether these findings changed acute management. Results: Of the 396 visits included, CT scans were obtained in 39%, and 8% of these scans demonstrated acute abnormalities. Patients who were older, had status epilepticus, a brain tumor, head trauma, or an abnormal examination were all significantly more likely to undergo acute neuroimaging ( P < .05). In the multivariable model, only history of brain tumor (odds ratio [OR] 5.88, 95% confidence interval [CI], 1.33-26.1) and head trauma as a result of seizure (OR 3.92, 95% CI, 1.01-15.2) reached statistical significance in predicting an acutely abnormal scan. The likelihood of an acute imaging abnormality in visits for patients without a history of brain tumor or head trauma as a result of the seizure was 2.7% (2 visits). Both of these patients had abnormal neurological examinations. Conclusion: Obtaining an emergent CT scan for patients with epilepsy presenting with a seizure may be avoidable in most cases, but might be indicated for patients with a history of brain tumor or head trauma as a result of seizure.

scholarly journals Assessment of the Awareness and Attitude of Emergency Physicians towards the use of Computed Tomography in patients with head injury in various hospitals in Anambra State, Nigeria

2020 ◽  
pp. 01-14
Author(s):  
Okechukwu Mary-Ann C
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Ct Scan ◽  
Imaging Modality ◽  
Head Injuries ◽  
Cross Sectional Study ◽  
Emergency Physicians ◽  
Cross Sectional ◽  
X Ray ◽  
Anambra State

The use of x-ray and computed tomography scan is critical in the management of traumatic conditions, particularly head injuries. This study was carried out to assess the level of awareness and attitude of Emergency physicians towards the use of CT in cases of head injury. A cross-sectional study was done among emergency physicians working in five different government hospitals in Anambra State. Among the respondents were 29% males and 4% females: mean age was 35.7 years while their modal age was 31-40 years. All the respondents, 33 (100%) stated they find CT scan as a useful diagnostic medical imaging modality. However less than half of them, 15 (45.5%) stated they refer patients for CT scan for those patients that need it. Whereas most of them, 20 (64.5%) stated that head injury patients should undergo both X-Ray and CT scan virtually all of them 32 (97%), responded that computed tomography, (CT) is better than skull x-ray in the examination of head injury. Though majority of the respondents 31 (93%), stated that CT scan subject the patient to some risks. All those who responded and thought that CT scan should continue to be used as medical diagnostic imaging modality were 33 (100%). The result of the study showed that most of the emergency physicians are aware of the usefulness of CT in the examination of patients presenting with head injury, but the non- availability and cost of services of the CT imaging equipment greatly affected the rate of request for the examination and has affected their attitude towards the use of this imaging modality in the examination of this category of patients in need of it.

scholarly journals 687 Timings of CT Scans in Suspected Renal Colic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Sabaratnam ◽  
R Callan ◽  
G Baptiste ◽  
T Miah ◽  
A Sharaf ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Low Dose ◽  
Renal Colic ◽  
Ct Scans ◽  
Considerable Proportion ◽  
Single Centre ◽  
Recurrence Rates ◽  
Nice Guidelines ◽  
Ureteric Colic

Abstract Aim Renal/ureteric colic is common; it has an annual incidence of 1-2 cases per 1000 people and has high recurrence rates. National Institute for Health and Care Excellence (NICE) guidelines recommend imaging within 24 hours of presentation for all patients with suspected renal or ureteric stones and, for most adults, a low-dose non-contrast computed tomography (CT) scan should be offered. We set out to assess adherence to this guidance within our centre. Method We reviewed the records of patients presenting with suspected renal colic from December 2019, up to and including March 2020, in a single centre. We assessed the proportion of adult patients who underwent a CT within 24 hours. Results The data from 95 patients aged 19-82 years was analysed. We found that 37(38.9%) patients did not receive a CT scan within 24 hours. 16(17%) patients waited over 1 week for a CT KUB. Conclusions Our findings show a considerable proportion of patients who did not receive a CT within the first 24 hours of presenting with suspected renal/ureteric colic. This has led to plans for a formal clinical pathway to be established within out trust.

Sign in / Sign up

Export Citation Format

Share Document