Incidental Findings on CT Scans in the Emergency Department

Objectives. Incidental findings on computed tomography (CT) scans are common. We sought to examine rates of findings and disclosure among discharged patients who received a CT scan in the ED.Methods. Retrospective chart review (Aug-Oct 2009) of 600 patients age 18 and older discharged home from an urban Level 1 trauma center. CT reports were used to identify incidental findings and discharge paperwork was used to determine whether the patient was informed of these findings.Results. There were 682 CT scans among 600 patients: 199 Abdomen & Pelvis, 405 Head, and 78 Thorax. A total of 348 incidental findings were documented in 228/682 (33.4%) of the scans, of which 34 (9.8%) were reported to patients in discharge paperwork. Patients with 1 incidental finding were less likely to receive disclosure than patients with 2 or more (). Patients age <60 were less likely to have incidental findings (). There was no significant disclosure or incidental finding difference by gender.Conclusions. While previous research suggests that CT incidental findings are often benign, reporting to patients is recommended but this is rarely happening.

Download Full-text

How Did the COVID-19 Pandemic Affect Trauma Volume at an Urban Level I Trauma Center?

The American Surgeon ◽

10.1177/00031348211054075 ◽

2022 ◽

pp. 000313482110540

Author(s):

Alexandra Hahn ◽

Tommy Brown ◽

Brett Chapman ◽

Alan Marr ◽

Lance Stuke ◽

...

Keyword(s):

Health Care ◽

Trauma Center ◽

Penetrating Trauma ◽

Retrospective Chart Review ◽

Trauma Patients ◽

Minor Trauma ◽

Significant Difference ◽

Urban Level ◽

Level 1 ◽

Level 1 Trauma Center

Introduction The COVID-19 pandemic changed the face of health care worldwide. While the impacts from this catastrophe are still being measured, it is important to understand how this pandemic impacted existing health care systems. As such, the objective of this study was to quantify its effects on trauma volume at an urban Level 1 trauma center in one of the earliest and most significantly affected US cities. Methods A retrospective chart review of consecutive trauma patients admitted to a Level 1 trauma center from January 1, 2017 to December 31, 2020 was completed. The total trauma volume in the years prior to the pandemic (2017-2019) was compared to the volume in 2020. These data were then further stratified to compare quarterly volume across all 4 years. Results A total of 4138 trauma patients were treated in the emergency room throughout 2020 with 4124 seen during 2019, 3774 during 2018, and 3505 during 2017 in the pre-COVID-19 time period. No significant difference in the volume of minor trauma or trauma transfers was observed ( P < .05). However, there was a significant increase in the number of major traumas in 2020 as compared to prior years (38.5% vs 35.6%, P < .01) and in the volume of penetrating trauma (29.1% vs 24.0%, P < .01). Discussion During the COVID-19 outbreak, trauma remained a significant health care concern. This study found an increase in volume of penetrating trauma, specifically gunshot wounds throughout 2020. It remains important to continue to devote resources to trauma patients during the ongoing COVID-19 pandemic.

Download Full-text

Syndesmotic Screw Removal in a Clinic Setting Is Safe and Cost-effective

Foot & Ankle Specialist ◽

10.1177/1938640019843321 ◽

2019 ◽

Vol 13 (2) ◽

pp. 144-151 ◽

Cited By ~ 1

Author(s):

Michelle T. Sugi ◽

Brandon Ortega ◽

Lane Shepherd ◽

Charalampos Zalavras

Keyword(s):

Operating Room ◽

Chart Review ◽

Cost Savings ◽

Retrospective Chart Review ◽

Cost Effective ◽

Level Of Evidence ◽

Superficial Infection ◽

Syndesmotic Screw ◽

Level 1 ◽

Level 1 Trauma Center

Background. There is no consensus in the literature regarding the necessity of syndesmotic screw removal, but the majority of surgeons prefer screw removal in the operating room. Purpose. The aim of this study is to analyze the safety and cost-effectiveness of syndesmotic screw removal in the clinic. Methods. A retrospective chart review was performed on all acute, traumatic ankle fractures that required syndesmotic stabilization over 5 years at a level 1 trauma center. Radiographs were evaluated for maintenance of syndesmotic reduction. Orthopaedic clinic visits and operating room costs were calculated. Results. Of 269 patients, syndesmotic screws were successfully removed in the clinic in 170 patients and retained in 99 patients. Two superficial infections (1.2%) developed following screw removal. The superficial infection rate was 3.3% (2 of 60) in patients who did not receive antibiotics compared with 0% (0 of 110) in patients who received antibiotics (P = .12). No patient lost syndesmotic reduction after screw removal. Cost savings of $13 829 per patient were achieved by syndesmotic screw removal in the clinic. Conclusion. Our study demonstrates that syndesmotic screw removal in the clinic is safe, does not result in tibiofibular diastasis, is cost-effective, and results in substantial financial savings. Level of Evidence: Level IV

Download Full-text

Crotalidae Polyvalent Immune Fab and Cost-Effective Management of Hospital Admissions for Snakebites

The American Surgeon ◽

10.1177/00031348211054566 ◽

2022 ◽

pp. 000313482110545

Author(s):

Mallory B. Bowden ◽

Dudley B. Christie ◽

Kelly H. Hand ◽

Anne Montgomery

Keyword(s):

Patient Population ◽

Chart Review ◽

Hospital Admissions ◽

Treatment Protocol ◽

Retrospective Chart Review ◽

Cost Effective ◽

Species Number ◽

Level 1 ◽

The Impact ◽

Level 1 Trauma Center

Background Venomous snakebites are a common clinical scenario in the Southeastern United States. CroFab® (Crotalidae Polyvalent Immune Fab (Ovine), BTG, Wales, UK) antivenom is indicated in cases involving pit vipers and is known to be expensive. The treatment protocol for snakebites is based on clinically subjective measures triggering the application, or escalation of, antivenom administration. The purpose of this study is to characterize the use of CroFab at our institution and to evaluate the impact of its use regarding cost and overall outcomes. We suspect that it is often used but potentially less often needed. We hypothesized that CroFab use was associated with increased length of stay (LOS) without an observed difference in patient outcomes. Materials and Methods A retrospective chart review of snakebite patients at our level-1 trauma center from 2000 to 2016 was performed. Snakebite location, snake species, number of vials of CroFab administered, hospital LOS, intensive care unit (ICU) LOS, and complications were identified for each patient. Patients were divided into CroFab (C) and no CroFab (NC) groups. Results One hundred ninety patients with venomous snakebites were included. 53.7% of patients received CroFab. There was no difference in the complication rate of C versus NC groups, ( P = .1118). CroFab use was associated with longer hospital LOS ( P < .0001) and ICU LOS ( P < .0001). Discussion CroFab use was associated with increased LOS in our patient population. There was no difference in observed outcomes between the C and NC groups. These findings imply that CroFab is potentially over-used in our patient population.

Download Full-text

Accuracy of institutional orthopedic trauma databases: a retrospective chart review

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02478-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Aman Chopra ◽

Abigail C. Cortez ◽

Ashraf El Naga ◽

Anthony Ding ◽

Saam Morshed

Keyword(s):

Quality Control ◽

Chart Review ◽

Capture Rate ◽

Data Entry ◽

Retrospective Chart Review ◽

Fracture Pattern ◽

Control Measures ◽

Injury Patterns ◽

Level 1 ◽

Level 1 Trauma Center

Abstract Introduction Academic trauma institutions rely on fracture databases as research and quality control tools. Frequently, these databases are populated by trainees, but the completeness and accuracy of such databases has not yet been evaluated. The purpose of this study is to determine the capture rate of a resident-populated database in collecting extremity fractures and to determine the accuracy of assigned Orthopaedic Trauma Association (OTA) classifications. Materials and methods A retrospective study was performed at a level 1 trauma center of all adult patients who underwent treatment for extremity fractures after an emergency department or inpatient consultation. A 20% random sample was taken from these entries and compared to a resident-populated fracture database designed to capture the same patients. For all matching records containing a resident-assigned OTA classification, relevant imaging was blindly reviewed by a trauma fellowship-trained orthopedic attending surgeon for fracture pattern classification. Resident OTA classifications were compared to this gold standard to determine overall accuracy rate. Results Three hundred eighteen (80%) out of 400 entries were captured by the resident-populated database. Two hundred thirty-one of these 318 entries contained an OTA classification. One hundred fifty-three (66%) of these 231 entries demonstrated concordance between resident and attending assigned OTA classifications. On subgroup analysis, 133 (70%) of the 190 lower extremity classifications were accurately identified as compared to just 20 (49%) of the 41 upper extremity classifications (p = 0.009). Seventy-nine (65%) of the 121 end segment fractures showed agreement versus 42 (67%) of the 63 diaphyseal injury patterns (p = 0.85). Accuracy of classification did not significantly vary by resident year of training (p = 0.142). Conclusion Trainee generated databases at academic institutions may be subject to incomplete data entry and inaccurate fracture classifications. Quality control measures should be instituted to ensure accuracy in such databases if efforts are invested with the expectation of useful information.

Download Full-text

Incidence of hypersensitivity reactions in patients on H1-receptor antagonists receiving oxaliplatin-based chemotherapy

Journal of Oncology Pharmacy Practice ◽

10.1177/10781552211003958 ◽

2021 ◽

pp. 107815522110039

Author(s):

Christine Barrett ◽

Seon Jo Park ◽

Lindsay Edmondson ◽

Dulabh Monga

Keyword(s):

Observational Study ◽

Chart Review ◽

Retrospective Chart Review ◽

Controlled Trials ◽

Severe Reaction ◽

Hypersensitivity Reactions ◽

H1 Receptor ◽

Receptor Antagonists ◽

Randomized Controlled ◽

To Receive

Objective This study determined the incidence of hypersensitivity reactions in patients receiving oxaliplatin-based chemotherapy while on H1-receptor antagonists (H1RAs). Prophylaxis for patients receiving oxaliplatin is not currently recommended. H1RAs are used for the treatment of reactions; however, prophylactic H1RAs have not been well-studied. Methods This retrospective chart review included patients with solid tumor malignancies who received H1RAs while on oxaliplatin-based chemotherapy between August 1, 2016 and October 31, 2019. Results Of fifty-one patients, there were four hypersensitivity reactions (8%), most of which were mild, occurred within 60 minutes of the start of the infusion, and did not result in an interruption in treatment. One severe reaction occurred, which required discontinuation of therapy. Forty-two patients (82%) were able to receive at least 9 cycles of oxaliplatin without a reported reaction. Conclusion In this observational study, the incidence rate of hypersensitivity reactions in patients receiving oxaliplatin while on H1RAs was lower than reported in previous literature. Most reactions were mild, and patients were able to continue oxaliplatin-based therapy. With future, randomized controlled trials, H1RAs may prove to be effective in preventing or delaying the onset of hypersensitivity reactions related to oxaliplatin.

Download Full-text

The mortality of ill infants with false tooth extraction in a rural Ugandan emergency department

Journal of Public Health in Africa ◽

10.4081/jphia.2017.582 ◽

2017 ◽

Vol 8 (1) ◽

Author(s):

Amyna Husain ◽

M. Douglas Baker ◽

Mark C. Bisanzo ◽

Martha W. Stevens

Keyword(s):

Emergency Department ◽

Tooth Extraction ◽

Chart Review ◽

Statistical Significance ◽

Univariate Analysis ◽

Retrospective Chart Review ◽

Cultural Practice ◽

Fluid Bolus ◽

Significant Difference ◽

To Receive

False tooth extraction (FTE), a cultural practice in East Africa used to treat fever and diarrhea in infants, has been thought to increase infant mortality. The mortality of clinically similar infants with and without false tooth extraction has not previously been examined. The objective of our retrospective cohort study was to examine the mortality, clinical presentation, and treatment of infants with and without false tooth extraction. We conducted a retrospective chart review of records of infants with diarrhea, sepsis, dehydration, and fever in a rural Ugandan emergency department. Univariate analysis was used to test statistical significance. We found the mortality of infants with false tooth extraction (FTE+) was 18% and without false tooth extraction (FTE−) was 14% (P=0.22). The FTE+ study group, and FTE− comparison group, had similar proportions of infants with abnormal heart rate and with hypoxia. There was a significant difference in the portion of infants that received antibiotics (P=0.001), and fluid bolus (P=0.002). Although FTE+ infants had clinically similar ED presentations to FTE− infants, the FTE+ infants were significantly more likely to receive emergency department interventions, and had a higher mortality than FTE− infants.

Download Full-text

03:45 PM Abstract No. 58 Reducing delayed first case start time: a quality improvement initiative in an urban level 1 trauma center

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2018.12.099 ◽

2019 ◽

Vol 30 (3) ◽

pp. S28-S29

Author(s):

A. Dunn ◽

B. Goodman ◽

K. Cothron ◽

P. Kiproff

Keyword(s):

Quality Improvement ◽

Trauma Center ◽

Quality Improvement Initiative ◽

Start Time ◽

First Case ◽

Urban Level ◽

Level 1 ◽

Level 1 Trauma Center

Download Full-text

Patient Contact Time and Prehospital Interventions in Hypotensive Trauma Patients: Should We Reconsider the “ABC” Algorithm When Time Is of the Essence?

The American Surgeon ◽

10.1177/0003134820940244 ◽

2020 ◽

Vol 86 (8) ◽

pp. 937-943

Author(s):

Scott Ninokawa ◽

Jessica Friedman ◽

Danielle Tatum ◽

Alison Smith ◽

Sharven Taghavi ◽

...

Keyword(s):

Injury Severity ◽

Wound Care ◽

Penetrating Trauma ◽

Trauma Patients ◽

Abc Algorithm ◽

New Injury Severity Score ◽

Urban Level ◽

Level 1 ◽

Needle Decompression ◽

Level 1 Trauma Center

Introduction There is disagreement in the trauma community concerning the extent to which emergency medical services (EMS) should perform on-scene interventions. Additionally, in recent years the “ABC” algorithm has been questioned in hypotensive patients. The objective of this study was to quantify the delay introduced by different on-scene interventions. Methods A retrospective analysis of hypotensive trauma patients brought to an urban level 1 trauma center by EMS from 2007 to 2018 was performed, and patients were stratified by mechanism of injury and new injury severity score (NISS). Independent samples median tests were used to compare median on-scene times. Results Among 982 trauma patients, median on-scene time was 5 minutes (interquartile range 3-8). In penetrating trauma patients ( n = 488) with NISS of 16-25, intubation significantly increased scene time from 4 to 6 minutes ( P < .05). In penetrating trauma patients with NISS of 10-15, wound care significantly increased scene time from 3 to 6 minutes ( P < .05). Tourniquet use, interosseous (IO) access, intravenous (IV) access, and needle decompression did not significantly increase scene time. Conclusion Understanding that intubation increases scene time in penetrating trauma, while IV and IO access do not, alterations to the traditional “ABC” algorithm may be warranted. Further investigation of prehospital interventions is needed to determine which are appropriate on-scene.

Download Full-text

Buccal versus Vaginal Misoprostol for Term Induction of Labor: A Retrospective Cohort Study

American Journal of Perinatology ◽

10.1055/s-0038-1675219 ◽

2018 ◽

Vol 36 (07) ◽

pp. 765-772 ◽

Cited By ~ 1

Author(s):

Meredith L. Dorr ◽

Rebecca C. Pierson ◽

Joanne Daggy ◽

Sara K. Quinney ◽

David M. Haas

Keyword(s):

Chart Review ◽

Retrospective Chart Review ◽

Induction Of Labor ◽

Premature Rupture Of Membranes ◽

Significant Difference ◽

Misoprostol Group ◽

Vaginal Misoprostol ◽

To Receive ◽

Time To Delivery ◽

Labor Outcomes

Objective To compare the efficacy of similar buccal and vaginal misoprostol doses for induction of labor. Study Design Retrospective chart review of 207 consecutive women undergoing term induction of labor with misoprostol. Misoprostol route and dosing were collected. Time to delivery and other labor outcomes (e.g., vaginal delivery less than 24 hours) were compared between women receiving buccal and vaginal misoprostol. Results There was no significant difference in time to delivery for women receiving buccal (median 18.2 hour, 95% confidence interval [CI] = [14.9, 21.5]) versus vaginal (median 18.3 hour, 95% CI = [15.0, 20.4]) misoprostol (p = 0.428); even after adjusting for covariates (p = 0.381). Women who presented with premature rupture of membranes were more likely to receive buccal misoprostol (92.7% received buccal vs. 7.3% received vaginal, p < 0.001). A similar number of women delivered vaginally in the buccal group (88.2%) and vaginal misoprostol group (86.8%, p = 0.835). The proportion of women who experienced uterine tachysystole or chorioamnionitis did not significantly differ by route of administration. Conclusion We found no significant differences in time to delivery or other labor outcomes between buccal or vaginal dosing of misoprostol in women undergoing labor induction at term.

Download Full-text