scholarly journals Teleradiology as a relevant indicator of the impact of COVID-19 pandemic management on emergency room activities: a nationwide worrisome survey

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Jordan Vatele ◽  
Stéphanie Gentile ◽  
Vivien Thomson ◽  
Bénédicte Devictor ◽  
Marine Cloux ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Emergency Room ◽  
Renal Colic ◽  
Emergency Services ◽  
Ct Scans ◽  
Gender Distribution ◽  
The Impact ◽  
Radiological Examinations ◽  
Body Ct ◽  
Multiple Traumas

Abstract Objectives To evaluate the impact of COVID-19’s lockdown on radiological examinations in emergency services. Methods Retrospective, multicentre analysis of radiological examinations requested, via our teleradiology network, from 2017 to 2020 during two timeframes (calendar weeks 5–8 and then 12–15). We included CT scans or MRIs performed for strokes, multiple traumas (Body-CT), cranial traumas (CTr) and acute non-traumatic abdominal pain (ANTAP). We evaluated the number and percentages of examinations performed, of those with a pathological conclusion, and of examinations involving the chest. Results Our study included 25 centres in 2017, 29 in 2018, 43 in 2019 and 59 in 2020. From 2017 to 2019, the percentages of examinations were constant, which was also true for chest CTs. Each centre’s number of examinations, gender distribution and patient ages were unchanged. In 2020, examinations significantly decreased: suspected strokes decreased by 36% (1052 vs 675, p < 0.001), Body-CT by 62% (349 vs 134, p < 0.001), CTr by 52% (1853 vs 895, p < 0.001) and for ANTAP, appendicitis decreased by 38% (45 vs 90, not statistically significant (NS)) sigmoiditis by 44% (98 vs 55, NS), and renal colic by 23% (376 vs 288, NS). The number of examinations per centre decreased by 13% (185.5 vs 162.5, p < 0.001), whereas the number of examinations of the "chest" region increased by 170% (1205 vs 3766, p < 0.001). Conclusion Teleradiology enabled us to monitor the impact of the COVID-19 pandemic management on emergency activities, showing a global decrease in the population's use of care.

scholarly journals Teleradiology as a relevant indicator of the impact of COVID-19 pandemic management on Emergency Room activities: a nationwide worrisome survey

2020 ◽  
Author(s):  
Jordan Vatele ◽  
Stephanie Gentile ◽  
Vivien THOMSON ◽  
Bénédicte DEVICTOR ◽  
Marine CLOUX ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Emergency Room ◽  
Renal Colic ◽  
Emergency Services ◽  
Ct Scans ◽  
Gender Distribution ◽  
The Impact ◽  
Radiological Examinations ◽  
Body Ct ◽  
Multiple Traumas

Abstract Objectives: To evaluate the impact of COVID-19’s lockdown on radiological examinations in Emergency Services.Methods: Retrospective, multicentre analysis of radiological examinations requested, via our teleradiology network, from 2017 to 2020 during two timeframes (calendar weeks 5 to 8 and then 12 to 15).We included CT-scans or MRIs performed for strokes, multiple traumas (body-CT, BC), cranial traumas (CTr) and acute non-traumatic abdominal pain (ANTAP). We evaluated the number and percentages of examinations performed, of those with a pathological conclusion, and of examinations involving the chest.Results: Our study included 25 centres in 2017, 29 in 2018, 43 in 2019 and 59 in 2020.From 2017 to 2019, the percentages of examinations were constant, which was also true for chest CTs. Each centre’s number of examinations, gender distribution and patient ages were unchanged.In 2020, examinations significantly decreased : suspected strokes decreased by 36% (1052 vs 675, p <0.001), BC by 62% (349 vs 134, p <0.001), CTr by 52% (1853 vs 895, p <0.001) and for ANTAP, appendicitis decreased by 38% (145 vs 90, NS) sigmoiditis by 44% (98 vs 55, NS), and renal colic by 23% (376 vs 288, NS).The number of exams per centre decreased by 13% (185.5 vs. 162.5, p <0.001) whereas the number of examinations of the "chest" region increased by 170% (1205 vs 3766, p <0.001).Conclusion: Teleradiology enabled us to monitor the impact of the COVID-19 pandemic management on emergency activities, showing a global decrease in the population's use of care

scholarly journals Teleradiology as a relevant indicator of the impact of COVID-19 pandemic management on Emergency Room activities: a nationwide worrisome survey

2020 ◽  
Author(s):  
Jordan Vatele ◽  
Stephanie Gentile ◽  
Vivien THOMSON ◽  
Bénédicte DEVICTOR ◽  
Marine CLOUX ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Emergency Room ◽  
Renal Colic ◽  
Emergency Services ◽  
Ct Scans ◽  
Gender Distribution ◽  
The Impact ◽  
Radiological Examinations ◽  
Body Ct ◽  
Multiple Traumas

Abstract Objectives: To evaluate the impact of COVID-19’s lockdown on radiological examinations in Emergency Services.Methods: Retrospective, multicentre analysis of radiological examinations requested, via our teleradiology network, from 2017 to 2020 during two timeframes (calendar weeks 5 to 8 and then 12 to 15).We included CT-scans or MRIs performed for strokes, multiple traumas (body-CT, BC), cranial traumas (CTr) and acute non-traumatic abdominal pain (ANTAP). We evaluated the number and percentages of examinations performed, of those with a pathological conclusion, and of examinations involving the chest.Results: Our study included 25 centres in 2017, 29 in 2018, 43 in 2019 and 59 in 2020.From 2017 to 2019, the percentages of examinations were constant, which was also true for chest CTs. Each centre’s number of examinations, gender distribution and patient ages were unchanged.In 2020, examinations significantly decreased : suspected strokes decreased by 36% (1052 vs 675, p <0.001), BC by 62% (349 vs 134, p <0.001), CTr by 52% (1853 vs 895, p <0.001) and for ANTAP, appendicitis decreased by 38% (145 vs 90, NS) sigmoiditis by 44% (98 vs 55, NS), and renal colic by 23% (376 vs 288, NS).The number of exams per centre decreased by 13% (185.5 vs. 162.5, p <0.001) whereas the number of examinations of the "chest" region increased by 170% (1205 vs 3766, p <0.001).Conclusion: Teleradiology enabled us to monitor the impact of the COVID-19 pandemic management on emergency activities, showing a global decrease in the population's use of care

scholarly journals Appropriate use of CT for patients presenting with suspected renal colic: a quality improvement study

2019 ◽  
Vol 8 (4) ◽  
pp. e000470 ◽  
Author(s):  
Jonah Himelfarb ◽  
Anand Lakhani ◽  
Dominick Shelton
Keyword(s):  
Quality Improvement ◽  
Radiation Exposure ◽  
Low Dose ◽  
Renal Colic ◽  
Target Population ◽  
Ct Imaging ◽  
Ct Scans ◽  
Low Dose Ct ◽  
Audit Period ◽  
The Impact

IntroductionCT use for renal colic has increased costs, radiation exposure and frequently does not alter management. Consequently, choosing wisely (CW) recommends avoiding CT imaging of otherwise healthy patients younger than 50 years presenting with symptoms of recurrent, uncomplicated renal colic. We evaluated the utilisation of CT imaging for this subgroup of patients and subsequently implemented a quality improvement initiative with an aim to reduce unnecessary radiation exposure.MethodsA retrospective chart review was performed for all patients younger than 50 years who visited Sunnybrook Health Sciences Centre emergency department (ED) between December 2015 and May 2016 with a discharge diagnosis of renal colic. After the audit period, emergency physicians were engaged to perform a root cause analysis and a driver diagram was developed. In December 2016, a clinical decision tool was introduced to standardise the imaging for patients with presumed renal colic. In May 2017, a separate electronic order was created for low-dose CT for renal colic, including a prompt to remind clinicians of the CW recommendation. The impact of these changes was measured over 15 months.ResultsOver the initial audit period, 17/63 (27%) of our target population received a CT to rule out renal colic. Many patients received multiple CT scans for renal colic during past ED visits, while one received a total of 13 CTs. At the time of our interventions, the baseline rate of CT scans in our target population was 37%, which reduced to 29% after our project began.ConclusionCT is often used as an initial diagnostic modality for suspected recurrent renal colic despite current guidelines. While this initiative caused only a modest change in management, it led to the introduction of a new low-dose CT scan order specifically to reduce radiation exposure in patients at risk for repeat scans.

scholarly journals Should We Report Incidental Low-Density Liver Lesions with Benign Features? A Retrospective Single-Centre Analysis of Trauma CT Scans

2020 ◽  
Author(s):  
Bob Zhang ◽  
Prasanna Ratnakanthan ◽  
Maryam Shekarforoush ◽  
Warren Clements
Keyword(s):  
Ct Scan ◽  
Negative Impact ◽  
The Body ◽  
Ct Scans ◽  
Low Density ◽  
Liver Lesions ◽  
Additional Imaging ◽  
The Impact ◽  
Body Ct

Abstract Background Many incidental liver lesions are benign and require no additional workup. Investigation of such lesions can have a negative impact of both the patient and health care system. However, the impact of how radiologists report these incidental lesions is not clear. We aimed to investigate how reporting of incidental liver lesions on trauma computed tomography (CT) scan affects follow-up. Methods This is a retrospective single-center analysis of body CT scans performed following abdominal trauma. Information was collected on the reporting of incidental low-density liver lesions and any additional imaging performed. Results A total of 3,595 trauma body CT scan reports were reviewed. Incidental liver lesions were identified in 527 (15%) patients, with 347 (10%) fulfilling the inclusion criteria. Additional imaging was requested by the referring doctor for 43 out of 285 patients (15%) when lesions were mentioned in the body of the report only, compared with 41 out of 62 patients (66%) when mentioned in the conclusion (odds ratio [OR] = 10.99, p < 0.0001). When additional imaging was recommended in the report, follow-up was arranged for 36 out of 52 patients (69%), compared with 48 out of 285 patients (16%) when it was not suggested (OR = 11.58, p < 0.0001). Additional imaging was requested for 84 of the 347 patients (24%), with 24 of these performed at our institution. All patients followed-up at our institution were diagnosed with a benign lesion. Conclusion Reporting incidental hypodense liver lesions in the conclusion or specifically recommending further additional imaging, both led to significantly increased likelihood of additional imaging being performed. Radiologists who encounter such lesions should consider excluding them from the conclusion if there are no malignant features or patient risk factors.

scholarly journals Decreased Medical Care During the COVID-19 Pandemic – A Comprehensive Analysis of Radiological Examinations

2021 ◽  
Author(s):  
Annette Aigner ◽  
Bernd Hamm ◽  
Florian Nima Fleckenstein ◽  
Tazio Maleitzke ◽  
Georg Böning ◽  
...  
Keyword(s):  
Medical Care ◽  
Control Period ◽  
Surrogate Marker ◽  
Medical Specialty ◽  
Case Volume ◽  
Medical Specialties ◽  
Key Points ◽  
Depth Analysis ◽  
The Impact ◽  
Radiological Examinations

Objectives As a cross-section discipline within the hospital infrastructure, radiological departments might be able to provide important information regarding the impact of the COVID-19 pandemic on healthcare. The goal of this study was to quantify changes in medical care during the first wave of the pandemic using radiological examinations as a comprehensive surrogate marker and to determine potential future workload. Methods A retrospective analysis of all radiological examinations during the first wave of the pandemic was performed. The number of examinations was compared to time-matched control periods. Furthermore, an in-depth analysis of radiological examinations attributed to various medical specialties was conducted and postponed examinations were extrapolated to calculate additional workload in the near future. Results A total of 596,760 examinations were analyzed. Overall case volumes decreased by an average of 41 % during the shutdown compared to the control period. The most affected radiological modalities were sonography (–54 %), X-ray (–47 %) followed by MRI (–42 %). The most affected medical specialty was trauma and orthopedics (–60 % case volume) followed by general surgery (–49 %). Examination numbers increased during the post-shutdown period leading to a predicted additional workload of up to 22 %. Conclusion This study shows a marked decrease in radiological examinations in total and among several core medical specialties, indicating a significant reduction in medical care during the first COVID-19 shutdown. Key Points: Citation Format

scholarly journals Examining the impact of mental disease on type 2 diabetes outcomes: results from the EpiChron Cohort

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I Guerrero Fernández de Alba ◽  
A Gimeno-Miguel ◽  
B Poblador Plou ◽  
K Bliek Bueno ◽  
J Carmona Pirez ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Substance Abuse ◽  
Early Detection ◽  
Health Outcomes ◽  
Emergency Room ◽  
Mental Disease ◽  
Emergency Room Visits ◽  
Mental Diseases ◽  
The Impact

Abstract Background Type 2 diabetes mellitus (T2D) is often accompanied by other chronic diseases, including mental diseases (MD). This work aimed at studying MD prevalence in T2D patients and analyse its impact on T2D health outcomes. Methods Retrospective, observational study of individuals of the EpiChron Cohort aged 18 and over with prevalent T2D at baseline (2011) in Aragón, Spain (n = 63,365). Participants were categorized by the existence or absence of MD, defined as the presence of depression, anxiety, schizophrenia or substance abuse. MD prevalence was calculated, and a logistic regression model was performed to analyse the likelihood of the four studied health outcomes (4-year all-cause mortality, all-cause hospitalization, T2D-hospitalization, and emergency room visits) based on the presence of each type of MD, after adjusting by age, sex and number of comorbidities. Results Mental diseases were observed in 19% of T2D patients, with depression being the most frequent condition, especially in women (20.7% vs. 7.57%). Mortality risk was significantly higher in patients with MD (odds ratio -OR- 1.24; 95% confidence interval -CI- 1.16-1.31), especially in those with substance abuse (OR 2.18; 95% CI 1.84-2.57) and schizophrenia (OR 1.82; 95% CI 1.50-2.21). The presence of MD also increased the risk of T2D-hospitalization (OR 1.51; 95% CI 1.18-1.93), emergency room visits (OR 1.26; 95% CI 1.21-1.32) and all-cause hospitalization (OR 1.16; 95% CI 1.10-1.23). Conclusions The high prevalence of MD among T2D patients, and its association with health outcomes, underscores the importance of providing integrated, person-centred care and early detection of comorbid mental diseases in T2D patients to improve disease management and health outcomes. Key messages Comprehensive care of T2D should include specific strategies for prevention, early detection, and management of comorbidities, especially mental disorders, in order to reduce their impact on health. Substance abuse was the mental disease with the highest risk of T2D-hospitalization, emergency room visits and all-cause hospitalization.

scholarly journals The impact of COVID-19 on the gender distribution of emergency medicine journal authors

2021 ◽  
Author(s):  
Alexandra Mannix ◽  
Melissa Parsons ◽  
Dayle Davenport ◽  
Sandra Monteiro ◽  
Michael Gottlieb
Keyword(s):  
Emergency Medicine ◽  
Gender Distribution ◽  
Medicine Journal ◽  
The Impact

Impact of routine S100B protein assay on CT scan use in children with mild traumatic brain injury

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Fleur Lorton ◽  
Jeanne Simon-Pimmel ◽  
Damien Masson ◽  
Elise Launay ◽  
Christèle Gras-Le Guen ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
University Hospital ◽  
S100b Protein ◽  
Research Network ◽  
Ct Scans ◽  
Intermediate Risk ◽  
Protein Assay ◽  
The Impact

AbstractObjectivesTo evaluate the impact of implementing a modified Pediatric Emergency Care Applied Research Network (PECARN) rule including the S100B protein assay for managing mild traumatic brain injury (mTBI) in children.MethodsA before-and-after study was conducted in a paediatric emergency department of a French University Hospital from 2013 to 2015. We retrospectively included all consecutive children aged 4 months to 15 years who presented mTBI and were at intermediate risk for clinically important traumatic brain injury (ciTBI). We compared the proportions of CT scans performed and of in-hospital observations before (2013–2014) and after (2014–2015) implementation of a modified PECARN rule including the S100B protein assay.ResultsWe included 1,062 children with mTBI (median age 4.5 years, sex ratio [F/M] 0.73) who were at intermediate risk for ciTBI: 494 (46.5%) during 2013–2014 and 568 (53.5%) during 2014–2015. During 2014–2015, S100B protein was measured in 451 (79.4%) children within 6 h after mTBI. The proportion of CT scans and in-hospital observations significantly decreased between the two periods, from 14.4 to 9.5% (p=0.02) and 73.9–40.5% (p<0.01), respectively. The number of CT scans performed to identify a single ciTBI was reduced by two-thirds, from 18 to 6 CT scans, between 2013–2014 and 2014–2015. All children with ciTBI were identified by the rules.ConclusionsThe implementation of a modified PECARN rule including the S100B protein assay significantly decreased the proportion of CT scans and in-hospital observations for children with mTBI who were at intermediate risk for ciTBI.

scholarly journals A78 THE IMPACT OFGASTROINTESTINAL FOLLOW UP CARE ON HEALTHCARE UTILIZATION IN PATIENTS WITH ESINOPHILICESOPHAGITID (EOE).

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 45-46
Author(s):  
K Alazemi ◽  
M Alkhattabi ◽  
J C Gregor
Keyword(s):  
Emergency Room ◽  
Healthcare Utilization ◽  
Attrition Rate ◽  
Quality Improvement Initiative ◽  
Food Impaction ◽  
Emergency Room Visits ◽  
True Rate ◽  
Funding Agencies ◽  
The Impact

Abstract Background EOE is an increasingly recognized gastrointestinal condition that causes significant morbidity ranging from dietary limitations to food impactions requiring emergency room visits. There are a variety of dietary, pharmacologic and endoscopic treatments available but most are more practically guided by a subspecialist familiar and experienced with the condition. There is a perception among some physicians that follow up is sporadic and may be related at least in part to patient compliance. Aims To assess the true rate of EOE patients follow up rate at Lodon Health Scince Center Methods We used a retrospective cohort of patients diagnosed with EoE between July 2011 and June 2014 who met the traditional diagnostic criteria. As part of a quality improvement initiative, local follow up over the ensuing 5–7 years was tracked. The impact of follow up on subsequent healthcare utilization was analyzed. Results 123 patients with biopsy confirmed EoE were analyzed. Follow up appointments were made for 114/123 (92%) patients. 55/123 (45%) had repeat elective endoscopy booked. Only 10/114 (8.7%) of initial appointments went unattended but 15/55 (27.2%) of the patients offered ongoing follow up failed to attend. There were no complications (ie. perforation or bleeding) attributable to any of the procedures. 5/123 (4%) patients required repeat emergency room endoscopy for food impaction. Two patients required this on multiple occasions. 4/5 patients requiring repeat emergency room endoscopy for food impaction had received some sort of follow up, although 4/5 of these had at least one missed appointment. 2/5 patients having emergency room endoscopy required overnight admission. There were no perforations in the cohort. Conclusions Patients with a confirmed diagnosis of EOE do have a risk of requiring subsequent emergency endoscopy for food impaction although it is not clear that scheduled follow up significantly reduces that risk. Contrary to the perception of some physicians, patients with EoE are very likely to attend their first follow up visit although the attrition rate for subsequent scheduled visits is not insignificant. Funding Agencies None

P007 CROHN’S DISEASE: PREDICTORS OF HOSPITAL DISPOSITION AND COSTS USING DEMOGRAPHIC, CLINICAL, AND TREATMENT DATA

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S48-S48
Author(s):  
Hartman Brunt ◽  
Mason Adams ◽  
Michael Barker ◽  
Diana Hamer ◽  
J C Chapman
Keyword(s):  
Logistic Regression ◽  
Crohn’S Disease ◽  
Abdominal Pain ◽  
Crohn's Disease ◽  
Hospital Admission ◽  
Categorical Variables ◽  
History Of ◽  
The Difference ◽  
The Impact ◽  
Total Charges

Abstract Purpose Crohn’s disease (CD) is an inflammatory bowel disease (IBD) caused by an abnormal immune response to intestinal microbes in a genetically susceptible host. The objective of this cohort analysis is to compare demographic characteristics, cost difference, and treatment modalities between patients who were discharged from the Emergency Department (ED) and those who were admitted to the hospital. Methods This study is a retrospective chart review of adult patients diagnosed with CD who were discharged from the ED and those who were admitted to the hospital between January 1, 2014 and January 1, 2017. We compared demographic and clinical characteristics as well as total charges incurred by these patients. A chi square test of independence and a Mann Whitney U-Test were used to compare categorical variables. Linear and logistic regression analyses were utilized to identify predictors of hospitalization and total charges. Results Of a total 195 patients, 97 were discharged from the ED and 98 were admitted to the hospital (Table 1). Patients who presented with fever, nausea/vomiting, or abdominal pain or who had a history of a fistula or stenosis were more likely to be hospitalized, as were patients who presented on steroids, 5-ASA compounds, or narcotics (Table 2). A logistic regression adjusted for these factors showed patients presenting with abdominal pain (OR=0.239, 95% CI 0.07 – 0.77) are less likely, while patients presenting with fever (OR=7.0, 95% CI 1.9 – 24.5) and history of stenosis (OR=17.8, 95% CI 5.7 – 55.9) are more likely to have a hospital admission. An increase in age and white blood cell count was associated with an increase in likelihood of admission (OR=1.04, 95% CI 1.01 – 1.07 and OR=1.2, 95% CI 1.1 – 1.4), while an increase in HGB was associated with a decrease in likelihood of admission (OR=0.682, 95% CI 0.55 – 0.83). Patients on 5-ASA compounds had the strongest association with hospital admission (OR=4.5, 95% CI 1.03 – 20.4). A linear regression analysis predicting total charges of hospitalization identified an increase of $37,500 (95% CI 6,600 – 68,489) for obese patients and of $29,000 (95% CI 20 – 57,000) for patients on narcotics prior to hospitalization. Notably, blacks were on average 6 years younger than whites (μ=36.2, st.d.=13.2 v μ=42.7, st.d.=18.2, p=0.031, respectively). No other differences in presentation or outcomes of CD were identified between these races. Conclusion This study describes the difference between CD patients who were admitted to the hospital compared to those who were discharged from the ED. The impact that 5-ASA compound, steroid, and narcotic use prior to presentation has on hospital admission and charges highlights the need for consistent outpatient care to manage the symptoms and disease progression in patients with CD in Baton Rouge. The difference in age at presentation between blacks and whites should also be considered in future research.

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