Can video-based telehealth examinations of the abdomen safely determine the need for imaging?

2021 ◽  
pp. 1357633X2110233
Author(s):  
Emily M Hayden ◽  
Pierre Borczuk ◽  
Sayon Dutta ◽  
Shan W Liu ◽  
Benjamin A White ◽  
...  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Observational Study ◽  
Confidence Interval ◽  
Usual Care ◽  
Emergency Physician ◽  
Abdominal Imaging ◽  
Emergency Department Care ◽  
Physical Examinations ◽  
Abdominal Examination

There is little evidence on the reliability of the video-based telehealth physical examinations. Our objective was to evaluate the feasibility of a physician-directed abdominal examination using telehealth. This was a prospective, blinded observational study of patients >19 years of age presenting with abdominal pain to a large, academic emergency department. In addition to their usual care, patients had a video-based telehealth examination by an emergency physician early in the visit. We compared the in-person and telehealth providers’ decisions on imaging. Thirty patients were enrolled and providers’ recommendations for imaging were YES (telehealth: 18 (60%); in-person: 22 (73%)), UNSURE (telehealth: 9 (30%); in-person: 2 (7%)) and NO (telehealth: 6 (20%); in-person: 3 (10%)). There were 20 patients for whom both telehealth and in-person providers were not unsure; of these, 16 (80%, 95% confidence interval 56.3–94.3%) patients had a provider agreement on the need for imaging. While the use of video-based telehealth may be feasible for patients seeking emergency department care for abdominal pain, further study is needed to determine how it may be safely deployed. Currently, caution should be exercised when evaluating the need for abdominal imaging remotely.

scholarly journals MP58: Have opioid prescription by emergency physicians changed significantly over five years?

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S63-S63
Author(s):  
M. Wei ◽  
M. Da Silva ◽  
J. Perry
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Tertiary Care ◽  
Opioid Analgesia ◽  
Emergency Physicians ◽  
Prescribing Practices ◽  
Chi Square ◽  
Opioid Prescription ◽  
Emergency Department Care ◽  
Undetermined Etiology

Introduction: It is believed by some that emergency physicians prescribe more opioids than required to manage patients’ pain, and this may contribute to opioid misuse. The objective of our study was to assess if there has been a change in opioid prescribing practices by emergency physicians over time for undifferentiated abdominal pain. Methods: A medical record review for adult patients presenting at two urban academic tertiary care emergency departments was conducted for two distinct time periods; the years of 2012 and 2017. The first 500 patients within each time period with a discharge diagnosis of “abdominal pain” or “abdominal pain not yet diagnosed” were included. Data were collected regarding analgesia received in the emergency department and opioid prescriptions written. Opioids were standardized into morphine equivalent doses to compare quantities of opioids prescribed. Analyses included t-test for continuous and chi-square for categorical data. Results: 1,000 patients were included in our study. The mean age was 42.0 years and 69.6% of patients were female. Comparing 2017 to 2012, there was a non-significant decrease in opioid prescriptions written for patients discharged directly by emergency physicians, from 17.8% to 14.4% (p = 0.14). Mean opioid quantities per prescription decreased from 130.4 milligrams of morphine equivalents per prescription to 98.9 milligrams per prescription (p = 0.002). 13.9% of opioid prescriptions in 2017 were for more than 3 days, which is a decrease from 28.1% in 2012. During the emergency department care, there was an increase in foundational analgesia use prior to initiating opioids from 17.6% to 26.8% (p = 0.001). There was also a decrease for within ED opioid analgesia use from 40.0% to 32.8% (p = 0.018). Conclusion: Opioid prescription rates did not change significantly during our study. However, physicians reduced the quantity of opioids per prescription and used less opioid analgesia in the emergency department for abdominal pain of undetermined etiology.

scholarly journals Organisational Determinants and Consequences of Diagnostic Discrepancy in Emergency Departments: A National Study of Consecutive Episodes Between 2008-2016

2020 ◽  
Author(s):  
Line Stjernholm Tipsmark ◽  
Børge Obel ◽  
Tommy Andersson ◽  
Rikke Søgaard
Keyword(s):  
Emergency Department ◽  
Hip Fracture ◽  
Observational Study ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Healthcare Sector ◽  
National Study ◽  
Common Phenomenon ◽  
Mixed Effect ◽  
Mixed Effect Models

Abstract Background Diagnostic discrepancy (DD) is a common phenomenon in healthcare, but little is known about its organisational determinants and consequences. Thus, the aim of the study was to evaluate this among selected emergency department (ED) patients. Method We conducted an observational study including all consecutive ED patients (hip fracture or erysipelas) in the Danish healthcare sector admitted between 2008 and 2016. DD was defined as a discrepancy between discharge and admission diagnoses. Episode and department statistics were retrieved from Danish registers. We conducted a survey among all Danish EDs (m=21) to inform organisational determinants. To estimate the results while adjusting for episode- and department-level heterogeneity, we used mixed effect models of ED organisational determinants and 30-day readmission, 30-day mortality and episode costs (2018-DKK) of DDs. ResultsDD was observed in 2,308 (3.3%) of 69,928 hip fracture episodes and 3,206 (8.5%) of 37,558 erysipelas episodes. The main organisational determinant of DD was senior physicians being employed at the ED (hip fracture: odds ratio (OR) 2.74, 95% confidence interval (CI) 2.15-3.51; erysipelas: OR 3.29, 95% CI 2.65-4.07). However, 24-hour presence of senior physicians (hip fracture) and availability of external senior physicians (both groups) were negatively associated with DD. DD was associated with increased 30-day readmission (hip fracture, mean 9.45% vs 13.76%, OR 1.46, 95% CI 1.28-1.66, p<0.001) and episode costs (hip fracture, 61,681 DKK vs 109,860 DKK, log cost 0.58, 95% CI 0.53-0.63, p<0.001; erysipelas, mean 20,818 DKK vs 56,329 DKK, log cost 0.97, 95% CI 0.92-1.02, p<0.001) compared with episodes without DD. Conclusion DD affects outcomes, and particular organisational characteristics seem to be associated with DD. Yet, the complexity of organisations and settings warrant further studies into these associations.

Predictors of Hand Hygiene in the Emergency Department

2011 ◽  
Vol 32 (11) ◽  
pp. 1120-1123 ◽  
Author(s):  
Arjun K. Venkatesh ◽  
Daniel J. Pallin ◽  
Stephanie Kayden ◽  
Jeremiah D. Schuur
Keyword(s):  
Emergency Department ◽  
Relative Risk ◽  
Observational Study ◽  
Confidence Interval ◽  
Hand Hygiene ◽  
Observation Unit

We conducted an observational study to identify predictors of hand hygiene (HH) in the emergency department. Compliance with HH was 89.7% over 5,865 opportunities. Observation unit, hallway or high-visibility location, glove use, and worker type predicted worse HH. Hallway location was the strongest predictor (relative risk, 88.9% [95% confidence interval, 85.9%–92.1%]).

A Rash Diagnosis

2020 ◽  
pp. 77-80
Author(s):  
Pat Croskerry
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Lumbar Puncture ◽  
Emergency Physician ◽  
Petechial Rash ◽  
Alternate Explanation

This case presents a 16-year-old female with complaints of headache, abdominal pain, diarrhea, and vomiting who is brought to the emergency department by her parents. The emergency physician is struck by a petechial rash on the patient’s face, which triggers a vivid memory of a similar rash in a patient with meningococcemia that proved fatal. A lumbar puncture is quickly done, and antibiotics are initiated. The patient is subsequently transferred to another physician, who finds an alternate explanation for the patient’s symptoms and refers her to surgery.

scholarly journals Colonic Interposition between the Liver and Diaphragm: “The Chilaiditi Sign”

2016 ◽  
Vol 2016 ◽  
pp. 1-2 ◽  
Author(s):  
Nita Nair ◽  
Zeina Takieddine ◽  
Hassan Tariq
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Colonic Interposition ◽  
Rebound Tenderness ◽  
Free Air ◽  
Abdominal Examination ◽  
Foley’S Catheter ◽  
The Right

A 90-year-old wheelchair bound male was brought to the emergency department with complaints of worsening abdominal pain over the last 2-3 days. The patient also had difficulty in passing urine. Abdominal examination revealed tenderness in the umbilical and hypogastric area without rebound tenderness or guarding. Computed tomography (CT) of the abdomen showed a loop of colon interpositioned between the liver and the right hemidiaphragm (the Chilaiditi sign), mimicking free air. Foley’s catheter was placed and the patient was managed conservatively. The patient clinically improved with improvement of the abdominal pain.

A Stone Left Unturned

2020 ◽  
pp. 253-258
Author(s):  
Pat Croskerry
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Young Woman ◽  
Crohn Disease ◽  
Emergency Physician ◽  
Hemorrhagic Cystitis ◽  
Correct Diagnosis ◽  
Technical Quality ◽  
History Of

In this case, a young woman presents to the emergency department with severe abdominal pain. She has a history of Crohn disease and this attack feels similar to previous flare-ups. The emergency physician orders urinalysis, blood work, and an abdominal series. Although the technical quality of his viewing of the images is limited, he is satisfied that there are no signs of obstruction or perforation. The patient settles well with analgesics and antiemetics. The urinalysis shows signs of infection, and the emergency physician prepares to discharge the patient on antibiotics for what he believes is hemorrhagic cystitis. At this point, a radiologist provides an interpretation of the patient’s abdominal series that allows for a correct diagnosis of her abdominal pain.

scholarly journals Emergency department visual urinalysis versus laboratory urinalysis

CJEM ◽  
2009 ◽  
Vol 11 (06) ◽  
pp. 540-543 ◽  
Author(s):  
James C. Worrall
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Confidence Interval ◽  
Urine Sample ◽  
Prospective Observational Study ◽  
Primary Objective ◽  
Reference Standard ◽  
Emergency Nurses ◽  
Convenience Sample ◽  
Blood Leukocyte

ABSTRACTObjective:The primary objective of this study was to compare the results of nurse-performed urinalysis (NPU) interpreted visually in the emergency department (ED) with laboratory-performed urinalysis (LPU) interpreted by reflectance photometry.Methods:This was a prospective observational study based on a convenience sample from my emergency practice. Emergency nurses, who were unaware of the study, performed usual dipstick analysis before sending the same urine sample to the laboratory for testing.Results:Of 140 urinalyses performed during the study period, 124 were suitable for analysis. When compared with the reference standard LPU, the NPU had an overall sensitivity of 100% (95% confidence interval [CI] 95%–100%) and a specificity of 49% (95% CI 33%–65%) for the presence of any 1 of blood, leukocyte esterase, nitrites, protein, glucose or ketones in the urine. Of 20 falsely positive NPUs, 18 were a result of the nurse recording 1 or more components as “trace” positive.Conclusion:Although NPU does not yield identical results to LPU, a negative LPU is expected when the initial NPU in the ED is negative.

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