scholarly journals SP10.1.2 Increased Access to Computed Tomography Reduces Acute Surgical Admissions: Lessons Learnt During the COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
S Davidson ◽  
L Cornett ◽  
K McElvanna
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Ct Scan ◽  
Surgical Patients ◽  
Lessons Learnt ◽  
Retrospective Audit ◽  
Time Period ◽  
Number Of Patients ◽  
Scan Data ◽  
Surgical Admission

Abstract Aim With increased bed pressures due to COVID-19, keeping patients out of hospital became critical. Computed Tomography (CT) utilisation was increased to aid in the assessment of acute surgical patients. The aim of this study was to assess if increased access to CT reduced inpatient admissions. Methods A Retrospective audit of patients presenting to the Emergency Department (ED) between 12th July – 23rd August 2020 who required a CT scan. Data collected from Electronic Care Records and NIPACS, including patient destination at time of CT and decision following CT. For comparison, the same time-period in 2019 was assessed. Results In 2020, 301 patients required a CT compared to 207 in 2019. 84.7% (255/301) had a CT direct from ED in 2020 vs. 56.5% (117/207) in 2019 (p < 0.001). Of those who had CT direct from ED in 2020 18.4% (47/255) were discharged, compared to 1.7% (2/117) in 2019 (p < 0.001). 9.8% (25/255) were directed to an alternative specialty in 2020 vs. 2.6% (3/117) in 2019 (p = 0.014). 2.7% (8/301) were discharged for an ambulatory CT in 2020, an increase from 0.5% (1/207) in 2019 (p = 0.07). Overall, there was a 24% reduction in the number of patients requiring acute surgical admission in 2020 vs. 2019. Conclusions There was a significant increase in the number of CT’s carried out directly from ED. This enabled a significant number of patients to be discharged or transferred to a more appropriate specialty. These results demonstrate that increased access to CT can reduce the need for acute surgical admission.

scholarly journals LO68: Patterns and predictors of emergency physician productivity

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S30-S31
Author(s):  
S. Campbell ◽  
S. Weerasinghe
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Ct Scan ◽  
Resource Utilization ◽  
Emergency Physician ◽  
X Ray ◽  
Workload Measurement ◽  
Number Of Patients ◽  
Return Visits

Introduction: Emergency Physician (EP) performance comprises both quality of care and quantity of patients seen in a set time. Emergency Department (ED) overcrowding increases the importance of the ability of EPs to see patients as rapidly as is safely possible. Maximizing efficiency requires an understanding of variables that are associated with individual physician performance. While using the incidence of return visits within 48 hours as a quality measure is controversial, repeat visits do consume ED resources. Methods: We analysed the practice variables of 85 EPs working at a single academic ED, for the period from June 1, 2013 to May 31, 2017, using data from an emergency department information system (EDIS). Variables analysed included: number of shifts worked, number of patients seen per hour (pt/hr), an adjusted workload measurement (assigning a higher score to CTAS 1-3 patients), percentage of patients whose care involved an ED learner, and the percentage of patients who returned to the ED within 48 hours of ED discharge. Resource utilization was measured by percentage of diagnostic imaging (ultra sound (US), CT scan (CT), x-ray (XR)) ordered and percentage of patients referred to consulting services. We performed principal component analyses to identify bench marks of resource use, demographic (age, EM qualification, gender) and other practice related predictors of performances. Results: Mean pt/hr differed significantly by EM Qualification for CTAS 2-4, with 1.71/hr (95% Confidence Interval=1.63-1.77) by FRCPS physicians, compared to 1.89/hr by CCFP(EM) (CI=1.81-1.97). There were no differences for CTAS 1 and 5. Other variables associated with a significantly lower pt/hr, included a greater use of imaging, (CT: p=0.0003, XR: p=0.0008) although this was did not reach statistical significance with US (p=0.06%). Female gender, older age, number of patient consultations for CTAS 3 and more patients seen by a learner were all associated with lower pt/hr. Pt/hr was a better predictor (R2=45%) for EP resource utilization than adjusted workload measurement (R2 =35%). Higher use of CT was associated with fewer return visits in <48 hrs (0.13% lower). Male gender, younger age, number of patient consultation for CTAS 3 and fewer patients seen by a learner were all associated with an increase in return visits. Conclusion: We found a significant difference in pt/hr rates and return visits within 48 hours between EPs with different age ranges, gender, and EM certification. Increased use of CT scan and x-ray, and consultation for patients CTAS 3 were associated with lower pt/hr. Return visit rates also varied in association with diagnostic imagine use, age, gender and number of patients seen by a learner. Further research is needed to assess the association with these variables on quality of care.

scholarly journals Incidence of bleeding in children undergoing circumcision with ketorolac administration

2017 ◽  
Vol 12 (1) ◽  
pp. E6-9 ◽  
Author(s):  
Bruce Gao ◽  
Taylor Remondini ◽  
Navraj Dhaliwal ◽  
Adrian Frusescu ◽  
Premal Patel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adverse Effects ◽  
Pain Control ◽  
Pediatric Patients ◽  
Surgical Patients ◽  
Risk Of Bleeding ◽  
Perioperative Bleeding ◽  
Number Of Patients ◽  
Increased Risk ◽  
Significant Difference

Introduction: Circumcision is the most common surgical procedure performed by pediatric urologists. Ketorolac has been shown to have an efficacy similar to morphine in multimodal analgesic regimens without the commonly associated adverse effects. Concerns with perioperative bleeding limit the use of ketorolac as an adjunct for pain control in surgical patients. As such, we sought to evaluate our institutional outcomes with respect to ketorolac and postoperative bleeding.Methods: We retrospectively reviewed all pediatric patients undergoing circumcision from January 1, 2014 to December 31, 2015 at the Alberta Children’s Hospital. Demographics, perioperative analgesic regimens, and return to emergency department or clinic for bleeding were gathered through chart review.Results: A total of 475 patients undergoing circumcisions were studied, including 150 (32%) who received perioperative ketorolac and 325 (68%) who received standard analgesia. Patients receiving ketorolac were more likely to return to the emergency department or clinic for bleeding (ketorolac group 19/150 [13%], non-ketorolac group 16/325 [5.0%]; p=0.005). Patients receiving ketorolac were more likely to have postoperative sanguineous drainage (ketorolac group 96/150 [64%], non-ketorolac group 150/325 [46%]; p<0.001). There was no significant difference in the number of patients requiring postoperative admission or further medical intervention.Conclusions: Although a promising analgesic, ketorolac requires additional investigation for safe usage in circumcisions due to possible increased risk of bleeding.

scholarly journals Exquisite air sac histological traces in a hyperpneumatized nanoid sauropod dinosaur from South America

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tito Aureliano ◽  
Aline M. Ghilardi ◽  
Bruno A. Navarro ◽  
Marcelo A. Fernandes ◽  
Fresia Ricardi-Branco ◽  
...  
Keyword(s):  
Computed Tomography ◽  
South America ◽  
Ct Scan ◽  
Upper Cretaceous ◽  
Postcranial Skeleton ◽  
Air Sacs ◽  
Neural Canal ◽  
Scan Data ◽  
Pneumatic Structures ◽  
First Time

AbstractThis study reports the occurrence of pneumosteum (osteohistological structure related to an avian-like air sac system) in a nanoid (5.7-m-long) saltasaurid titanosaur from Upper Cretaceous Brazil. We corroborate the hypothesis of the presence of an air sac system in titanosaurians based upon vertebral features identified through external observation and computed tomography. This is the fifth non-avian dinosaur taxon in which histological traces of air sacs have been found. We provided a detailed description of pneumatic structures from external osteology and CT scan data as a parameter for comparison with other taxa. The camellate pattern found in the vertebral centrum (ce) of this taxon and other titanosaurs shows distinct architectures. This might indicate whether cervical or lung diverticula pneumatized different elements. A cotylar internal plate of bone tissue sustains radial camellae (rad) in a condition similar to Alamosaurus and Saltasaurus. Moreover, circumferential chambers (cc) near the cotyle might be an example of convergence between diplodocoids and titanosaurs. Finally, we also register for the first time pneumatic foramina (fo) and fossae connecting camellate structures inside the neural canal in Titanosauria and the second published case in non-avian dinosaurs. The extreme pneumaticity observed in this nanoid titanosaur contrasts with previous assumptions that this feature correlates with the evolution of gigantic sizes in sauropodomorphs. This study reinforces that even small-bodied sauropod clades could present a hyperpneumatized postcranial skeleton, a character inherited from their large-bodied ancestors.

scholarly journals Sonographic Bedside Quantification of Pleural Effusion Compared to Computed Tomography Volumetry in ICU Patients

2018 ◽  
Vol 4 (04) ◽  
pp. E131-E135 ◽  
Author(s):  
Ulf Teichgräber ◽  
Judith Hackbarth
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Ct Scan ◽  
Supine Position ◽  
Cost Effective ◽  
Pleural Effusions ◽  
Icu Patients ◽  
The Us ◽  
Volumetric Estimation ◽  
Scan Data

Abstract To date, the reliability of ultrasound for the quantitative assessment of pleural effusion has been limited. In the following study, an easy and cost-effective bedside ultrasound method was developed and investigated for specific use in the intensive care unit (ICU). 22 patients (median age: 58.5 years, range: 37–88 years, 14 men and 8 women) with a total of 31 pleural effusions were examined in the ICU. The inclusion criterion was complete visualization of the effusion on chest computed tomography (CT). The ultrasound (US) examination was performed less than 6 h after the diagnostic CT scan. The pleural effusion volume was calculated volumetrically from the CT scan data. Within 4.58 +/- 2.87 h after the CT scan, all patients were re-examined with US in the ICU. The fluid crescent's thickness was measured between each intercostal space (ICS) with the patient in a supine position and a 30° inclination of the torso. The US measurements were compared to the calculated CT volumes using regression analysis, resulting in the following formula: V=13.330 x ICS6 (V=volume of the effusion [ml]; ICS6=sonographic measurement of the thickness of the liquid crescent [mm] in the sixth ICS).A significant correlation between the sonographically measured and the CT-calculated volumes was best observed for the sixth ICS (R2=0.589; ICC=0.7469 with p<0.0001 and a 95% CI of 0.5364–0.8705).The sonographic assessment of pleural effusions in a supine position and a 30° inclination of the torso is feasible for the volumetric estimation of pleural effusion. This is especially true for ICU patients with severe primary diseases and orthopnea who are unable to sit upright or lie flat.

A STUDY OF PROFILE OF MULTIDETECTOR COMPUTED TOMOGRAPHY IN MAXILLO-FACIAL INJURIES IN A TERTIARY CARE CENTER

2021 ◽  
pp. 23-26
Author(s):  
Saurabh Shivprasad Kakani ◽  
Saurabh Padiya ◽  
Asmita Surywanshi ◽  
Ejaj Patel
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Ct Scan ◽  
Care Center ◽  
Tertiary Care ◽  
Care Hospital ◽  
Age Group ◽  
Maxillofacial Injuries ◽  
Facial Injuries ◽  
Orbital Wall

Maxillofacial injuries account for a large group of patients in the emergency department in tertiary care hospital, presenting as an isolated injury or a part of poly trauma. Road trafc accidents are the commonest cause of maxillofacial injuries. Such injuries are clinically important as they cause facial disgurement and thus imposing emotional, morbidity and cosmetic dependence. To observe these fractures and decide appropriate management lines, there is a need for imaging aid. The main purpose of imaging guidance is to nd and characterize the fractures and associated injuries. Aim:Study of prole of multi detector computed tomography in maxillo-facial injury in a tertiary care centre. Materials and methods: The cases coming to the emergency department and then forwarded to department of Radiology, MGM medical college and hospital, Aurangabad for CT scan formed the source of the data and were studied in detail. Detailed history of the cases was taken. Written and informed consent were taken for undergoing CT scan examination. Patients were scanned using 16 slice Toshiba acquilion machine. The data was tabulated and observed and conclusions were made. Results: Total 175 number of patient were included in the study and CT scan for maxillo-facial injuries were conducted. Diagnosis of the maxillofacial injuries were done and the fractures were classied according to age, gender, location and its subsets. According to our study 21-30 years of age group was the most common age group to be involved in maxillo-facial injuries. Frequency of maxillo-facial injuries was found to be more in male than female. Maxillo facial injuries occurred mostly due to road trafc accidents. Orbit was seen as the most common bone to be fractured followed by fracture of maxilla bone. Orbital wall fracture happen to be overall most common bone affected amongst all the other facial bones.

Guideposts for Inserting Intercuneiform Joint Arthrodesis Screws: Analysis Using Multiplanar Reconstructed Computed Tomography

2018 ◽  
Vol 12 (2) ◽  
pp. 175-180
Author(s):  
Yuji Maenohara ◽  
Takumi Matsumoto ◽  
Song Ho Chang ◽  
Jun Hirose ◽  
Sakae Tanaka
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Anatomical Structure ◽  
Entry Point ◽  
Medial Aspect ◽  
Screw Insertion ◽  
Plantar Surface ◽  
Medial Cuneiform ◽  
Flat Feet ◽  
Scan Data

Intercuneiform arthrodesis is often required for various midfoot pathologies; however, intercuneiform screw insertion is not easy due to the complicated anatomical structure of cuneiforms. This study aimed to determine the advisable screw entry point and direction using intraoperatively detectable landmarks. The computed tomography (CT) scan data of feet were reformatted using OsiriX software multiplanar reconstruction. First, based on the data of 10 CT scans of normal feet, we determined the advisable screw entry point at the upper one-third in the dorsoplantar direction and center in the anteroposterior direction on the medial aspect of the medial cuneiform and insertion direction toward the outermost point of the base of the fifth metatarsal in the axial plane and parallel to the plantar surface in the coronal plane. Second, we examined the accuracy of these newly designed guideposts in the simulation using other CT scan data of the other 27 normal feet and 12 flat feet. The simulated screw trajectory penetrated the mid three-fifths of all three cuneiforms in 97% of the normal feet and 92% of the flat feet with no cases of cortical wall violation. Levels of Evidence: Level V: Expert opinion

Symptoms of Sternal Nonunion Late after Cardiac Surgery

2015 ◽  
Vol 65 (04) ◽  
pp. 325-331
Author(s):  
Irina Rinta-Kiikka ◽  
Matti Tarkka ◽  
Jari Laurikka ◽  
Juha Hautalahti
Keyword(s):  
Computed Tomography ◽  
Odds Ratio ◽  
Bone Mineralization ◽  
Surgical Patients ◽  
Ct Scans ◽  
Mineralization Rate ◽  
Imaging Studies ◽  
Initial Operation ◽  
Body Movements ◽  
Number Of Patients

Background A cohort of patients having symptoms of sternal nonunion late after sternotomy was studied to find out whether the complaints were related to true sternal nonunion or decreased bone density. Methods A survey was mailed to 2,053 cardiac surgical patients operated in our institution between July 2007 and June 2010. The patients were requested about symptoms referring to sternal instability. A group of symptomatic individuals as well as 1:1 age- and time-matched asymptomatic controls were examined with sternal palpation, ultrasound during standardized sternal pressure provocation, and computed tomography (CT). Results The number of patients replied in the survey was 1,918 (93.4%); 2.3% (44 patients) reported sensation of movement or clicking in sternum during body movements and during coughing. Symptomatic patients living within 200 km to the hospital (21) and their asymptomatic controls (21) were selected for further clinical and imaging studies. Mean period between the initial operation and the examinations was 36 (22–56) months. Sternal palpation pain was significantly associated with reported symptoms suggestive of sternal nonunion (odds ratio [OR] 22.0; 95% confidence interval [CI] 2.5–195); however, none of the patients had clinically unstable sternum or nonunion in the sternal imaging. The symptoms of sternal instability were more frequent in patients whose bone mineralization rate (as measured with T-scores) was higher. Conclusion Symptoms suggestive of sternal nonunion were experienced by 2.3%. However, their symptoms did not correlate with CT scans or provocation ultrasound although palpation pain was evident. Thus the pain is derived from nonmechanical etiologies. Higher bone mineralization rate correlated with abnormal symptoms of sternal wound.

Computed tomography scanning for three-dimensional imaging and complexity analysis of developing root systems

2005 ◽  
Vol 83 (11) ◽  
pp. 1434-1442 ◽  
Author(s):  
Melinda Lontoc-Roy ◽  
Pierre Dutilleul ◽  
Shiv O. Prasher ◽  
Liwen Han ◽  
Donald L. Smith
Keyword(s):  
Computed Tomography ◽  
Fractal Dimension ◽  
Ct Scan ◽  
Root System ◽  
Complexity Analysis ◽  
Three Dimensional ◽  
Root Systems ◽  
Soil Conditions ◽  
Advanced Analysis ◽  
Scan Data

To improve our understanding of the role of root systems in soil-based resource acquisition by plants and eventually model it completely, root system complexity must be quantified, in addition to other morphometric traits. In this note, we introduce a new approach in which computed tomography (CT) scan data are collected on crop root systems in three-dimensional (3-D) space nondestructively and noninvasively, thus allowing for repeated measurements and a relevant complexity analysis of root systems. The experimental crop is maize ( Zea mays L.). Four potted seedlings were CT scanned under wet soil conditions on the day of emergence, and each of the two following days. Specifically, a high-resolution X-ray CT scanner formerly used for medical purposes produced 3 × 500 CT images of 0.1 mm thick cross-sections for each seedling. The fractal dimension of each root system on each day was estimated on a skeletonized 3-D image reconstructed from CT scan data. We found that the mean fractal dimension value was not significantly greater than 1 on day 1 (1.015 ± 0.015), contrary to days 2 and 3 (1.037 ± 0.015, 1.065 ± 0.016). Our results, including original 3-D images, provide support for a novel type of root system studies based on the collection and advanced analysis of CT scan data.

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