scholarly journals Does Computed Tomography of Kidney, Ureter and Bladder (CTKUB) Affect The Management of Patients with Suspected Renal Colic in Emergency Department?

2021 ◽  
Author(s):  
Mehmood Chaudhry ◽  
Rasha Buhumaid ◽  
Khulood A Al Haj Banimatar ◽  
Ruqya Al Zaabi ◽  
Ismail Al Ramahi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Retrospective Study ◽  
Renal Colic ◽  
Study Cohort ◽  
Summary Statistics ◽  
Chi Square ◽  
Chi Square Analysis ◽  
Study Participants ◽  
Urological Intervention

Abstract Introduction CTKUB use in patients presenting to Emergency Department (ED) with suspected renal colic has increased by 10-fold over last few years. However, its impact on the urological intervention is not fully known.Methods We performed a retrospective study of adult patients, presenting consecutively to ED with suspected renal colic who underwent CTKUB from January to June 2014. We calculated descriptive summary statistics for analysis to determine the association of predefined radiological and patients’ characteristics on the urological intervention.Results Of the 282 patients enrolled in the study, 38% had stones. Commonest locations of stone were ureter (15%), uretero-vesical junction (12.4%). Of the study participants, 2% of the patients underwent urological intervention. Chi Square analysis did not find any significant associations between radiological or patients related characteristics and urological interventionConclusion There was no significant correlation between CTKUB findings or patients’ characteristics and urological intervention in this study cohort.

scholarly journals Findings of Non-enhanced Abdominal Computed Tomography for Pain Management of Acute Renal Colic Patients in the Emergency Department

2020 ◽  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Soft Tissue ◽  
Renal Colic ◽  
Repeated Administration ◽  
Pain Medication ◽  
Ureteral Stones ◽  
Large Size ◽  
Acute Renal Colic ◽  
Enhanced Computed Tomography

Study Objectives: To identify non-enhanced computed tomography (NECT) findings related to repeated requirement of painkiller, hospitalization and revisits within 5 days of discharge among acute renal colic patients. Patients and methods: A retrospective observational study was performed for all patients (age > 18 years) with acute renal colic who visited the emergency department (ED) between 2012 and 2015. NECT findings of acute ureterolithiasis (size, location, hydronephroureter, perinephric infiltrations and soft-tissue rim sign) were analysed for their relationships to repeated administration of painkiller, hospitalization and ED revisit. Results: Of total 862 patients enrolled, 305 (35.4%) required repeated administration of pain medication. In the NECT findings, hydronephroureter was more prevalent in the repeated administration of painkiller group (61.3% vs. 53.7%), but did not show independent relationship. Sixty-eight (7.9%) were hospitalized and 44 (5.1%) returned to the ED. The significant findings associated with hospitalization were hydronephroureter (OR [Odd Ratio] 1.92, 95%CI [Confidence Intervals] 1.04–3.54) and mid (5–7 mm) / large-size (> 7mm) ureteral stones (OR 2.66, 95% CI 1.49–4.76 and OR 4.78, 95% CI 1.80–12.70). The soft-tissue rim signs (OR 2.16, 95%CI 1.07–4.37) and proximal/mid location of stones (OR 3.21, 95% CI 1.26–8.20 and OR 2.53, 95% CI 1.19–5.37) were independently associated with ED revisit. Conclusions: Among the NECT findings of acute ureterolithiasis, hydronephroureter and stones > 5 mm in size were independently associated with the need of hospitalization. The soft-tissue rim sign and proximal/mid location of stones were independently associated with ED revisit within 5 days.

Use of Head Computed Tomography (CT) in the Pediatric Emergency Department in Evaluation of Children With New-Onset Afebrile Seizure

2018 ◽  
Vol 33 (11) ◽  
pp. 708-712 ◽  
Author(s):  
Aravindhan Veerapandiyan ◽  
Akilandeswari Aravindhan ◽  
James Huynh Takahashi ◽  
Devorah Segal ◽  
Keith Pecor ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Pediatric Emergency ◽  
Cranial Computed Tomography ◽  
Seizure Type ◽  
Pediatric Emergency Department ◽  
Seizure Duration ◽  
Chi Square ◽  
Head Ct ◽  
Afebrile Seizure

Objective: Cranial computed tomography (CT) is not recommended in the routine evaluation of children with first afebrile seizure due to its low yield. The objective was to assess the current practice in our pediatric emergency department regarding the use of head CT in children with first afebrile seizure and to identify the factors that lead to ordering a head CT. Methods: Medical records of patients between 1 month and 18 years old evaluated at our emergency department for presentation of first afebrile seizure between 2010 and 2014 were retrospectively reviewed. Data extracted include age, gender, seizure type, single or multiple seizures at presentation, seizure duration, predisposing conditions to seizures (ie, history of developmental delay), and whether a head CT was performed. Contingency tables with chi-square analyses were used to determine which variables were associated with increased use of head CT. Results: Of 155 patients (88M/67F) included in the study, 72 (46.5%) underwent head CT and only 3 had clinically significant findings that did not require acute management. There were no differences in CT use by age, sex, seizure type, seizure number, seizure risk factors, or findings on physical examination. Head CT was performed more frequently in cases with seizures ≥5 minutes and unknown seizure duration ( P = .04). Conclusion: Despite existing evidence, the emergent head CT rate was high in our cohort. Children with seizure duration of ≥5 minutes or of unknown duration were more likely to undergo head CT in our emergency department.

scholarly journals Identifying High-Risk Children in the Emergency Department

2016 ◽  
Vol 31 (10) ◽  
pp. 660-666 ◽  
Author(s):  
Katie R. Nielsen ◽  
Russ Migita ◽  
Maneesh Batra ◽  
Jane L. Di Gennaro ◽  
Joan S. Roberts ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Characteristic Curve ◽  
Pediatric Intensive Care ◽  
Receiver Operator Characteristic Curve ◽  
Clinical Deterioration ◽  
Chi Square ◽  
Inpatient Ward ◽  
Increased Risk ◽  
Chi Square Analysis

Purpose: Early warning scores (EWS) identify high-risk hospitalized patients prior to clinical deterioration; however, their ability to identify high-risk pediatric patients in the emergency department (ED) has not been adequately evaluated. We sought to determine the association between modified pediatric EWS (MPEWS) in the ED and inpatient ward-to-pediatric intensive care unit (PICU) transfer within 24 hours of admission. Methods: This is a case–control study of 597 pediatric ED patients admitted to the inpatient ward at Seattle Children’s Hospital between July 1, 2010, and December 31, 2011. Cases were children subsequently transferred to the PICU within 24 hours, whereas controls remained hospitalized on the inpatient ward. The association between MPEWS in the ED and ward-to-PICU transfer was determined by chi-square analysis. Results: Fifty children experienced ward-to-PICU transfer within 24 hours of admission. The area under the receiver–operator characteristic curve was 0.691. Children with MPEWS > 7 in the ED were more likely to experience ward-to-PICU transfer (odds ratio 8.36, 95% confidence interval 2.98-22.08); however, the sensitivity was only 18.0% with a specificity of 97.4%. Using MPEWS >7 for direct PICU admission would have led to 167 unnecessary PICU admissions and identified only 9 of 50 patients who required PICU care. Conclusions: Elevated MPEWS in the ED is associated with increased risk of ward-to-PICU transfer within 24 hours of admission; however, an MPEWS threshold of 7 is not sufficient to identify more than a small proportion of ward-admitted children with subsequent clinical deterioration.

Rectal tenesmus as a frequent symptom in renal colic: a retrospective study of 4758 patients from Emergency Department

2019 ◽  
Author(s):  
Jie Zhu ◽  
Yi Cao ◽  
Yanhua Lu ◽  
Miao Chen ◽  
Menglei Yu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Renal Colic ◽  
Gastrointestinal Symptoms ◽  
General Information ◽  
Therapeutic Effects ◽  
Registration Number ◽  
Medical Histories ◽  
Accompanying Symptoms ◽  
Information Characteristics

Abstract Background: To investigate the frequency of rectal tenesmus in urolithiasis patients presented with renal colic, and describe the clinical characteristics of these patients. Methods: A retrospective study across three large hospitals in Guangzhou was conducted, and all Emergency Department (ED) visits with renal colic during 2016 were included. Finally a total of 4758 patients were enrolled, and we collected then analyzed their medical histories, including general information, characteristics of renal colic, accompanying symptoms, as well as the signs, the typical examination results and the therapeutic effects. Results: The frequency of tenesmus in the patients with renal colic was 72.5%, higher than urinary irritation symptoms (23.4%) and the upper gastrointestinal symptoms (54.9%). Patients with tenesmus tended to suffer from renal colic during morning time (0:00-12:00) and at sleep or rest status. Higher likelihood of stones located in lower ureter (p<0.001) were found in this cohort of patients. Conclusions: Rectal tenesmus is a common accompanying symptom in patients presented with renal colic. This manifestation is related to certain characteristics of the patients and the stones. Future studies will be conducted to explore the feasibility of using rectal tenesmus in differential diagnosis for renal colic and other acute abdominal pain in ED. Trial registration The study was approved by the Institute Research Ethics Committee at the Sun Yat-sen University. The approval number is 2016 No. 59 of Sun Yat-sen Memorial Hospital. The study was retrospectively registered at http://www.chictr.org.cn/index.aspx (registration number: ChiCTR-RRC-17012373) in 15 August 2017.

scholarly journals Appropriateness of Radiology Test Requests by an Emergency Department: A Retrospective Study

2020 ◽  
Vol 33 (1) ◽  
pp. 7 ◽  
Author(s):  
Rute Martins ◽  
Pedro Raimundo ◽  
Pedro Alves ◽  
Rodrigo Monteiro ◽  
Luís Duarte Silva ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Retrospective Study ◽  
Odds Ratio ◽  
Clinical Information ◽  
Statistical Association ◽  
Clinical Context ◽  
Association Tests ◽  
Chi Squared ◽  
Relevant Finding

Introduction: Imaging tests are essential for diagnosis in the emergency context and convey clinical information that is essential to assess the appropriateness of the tests and improve their interpretation. Therefore, we aimed to analyze the imaging tests requested by the Emergency Department in a district hospital.Material and Methods: We retrospectively analyzed computed tomography and ultrasound scans requested by the Emergency Department at the Centro Hospitalar Universitário do Algarve and considered the following variables: requested test, clinical information provided (complete/incomplete), appropriateness of the test (appropriate/inappropriate), outcome (presence/absence of relevant findings) and findings related to the clinical information (yes/no). Pearson’s chi-squared and odds ratio association tests were used to evaluate the statistical association between the variables.Results: Out of 1427 requests, only 219 (15.3%) were considered to have complete clinical information. Nonetheless, 1075 (75.3%) requests were considered appropriate. Relevant findings were present in about one-third (n = 453; 31.7%) and most of these findings were related to the clinical context (n = 410; 90.5%). There was a significant association between test appropriateness and the presence of relevant findings in the test (p < 0.001). The odds ratio of having a relevant finding was 5.0 times higher in the tests considered appropriate when compared with those classified as inappropriate (CI = 3.4 - 7.3; p < 0.001).Discussion: The fact that appropriate tests potentiate the probability of having a relevant finding emphasizes the importance of defining guidelines so that only the adequate tests are performed.Conclusion: Creating guidelines should improve the appropriateness of imaging tests requested in the Emergency Department, yielding their result, with the consequent rationalization of the available resources.

A Pilot Study Characterising Interruptions Experienced By Emergency Medicine Residents

2018 ◽  
Vol 62 (1) ◽  
pp. 474-477
Author(s):  
Katherine L. Forsyth ◽  
Hunter J. Hawthorne ◽  
Nibras El-Sherif ◽  
Skylar M. Pagel ◽  
Renaldo C. Blocker
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Pilot Study ◽  
Chi Square ◽  
Post Graduate ◽  
Task Priority ◽  
Chi Square Analysis ◽  
And Task

Interruptions in the emergency department (ED) have been studied across multiple clinical roles, with little investigation into how residents experience interruptions. Therefore this pilot study aimed to characterize interruptions experienced by emergency medicine (EM) residents at various post-graduate year (PGY) levels. Observers shadowed ED residents across entire shifts and logged interruptions that affected clinicians into the Workflow Interruption Tool (WIT). Interruption characteristics captured included duration, nature, location, and task priority. Chi-square analysis identified a significant association between interruption type and the interruption priority, p < 0.001. Residents at varying PGY-levels experienced significantly different amounts of interruptions, p=0.013. Observing resident interruptions across the entirety of their shifts identified that as EM residents gain more experience, they are interrupted more often while working in the ED.

Sex‐related Differences in Emergency Department Renal Colic Management: Females Have Fewer Computed Tomography Scans but Similar Outcomes

2016 ◽  
Vol 23 (10) ◽  
pp. 1153-1160 ◽  
Author(s):  
Grant D. Innes ◽  
Frank X. Scheuermeyer ◽  
Michael R. Law ◽  
Andrew D. McRae ◽  
Bryce A. Weber ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Renal Colic ◽  
Computed Tomography Scans

High Prevalence of Visual Midline Shift Syndrome in TBI: A Retrospective Study

2016 ◽  
pp. 176-182
Keyword(s):  
Retrospective Study ◽  
Goodness Of Fit ◽  
Common Finding ◽  
P Value ◽  
Midline Shift ◽  
Goodness Of Fit Test ◽  
Chi Square ◽  
Group 13 ◽  
History Of ◽  
Chi Square Analysis

Background: Visual Midline Shift Syndrome (VMSS) is a common finding in patients who have suffered traumatic brain injury (TBI) and stroke. Proper identification of VMSS will allow for best patient management since VMSS has previously been shown to be treatable with Yoked Prism lenses. The purpose of this study was to determine the prevalence of VMSS in a group of patients with TBI compared to patients with no report of TBI. Methods: A single-center retrospective study of 60 patients (30 TBI and 30 non-TBI) was conducted by chart review to determine the prevalence and direction of VMSS in each group. The presence of VMSS was determined by Visual Midline Shift Testing where the patient was instructed to follow a moving Wolff Wand fixation target performed at 3 gazes horizontally from both directions to detect any right or left VMSS and then the procedure was repeated vertically to detect any anterior or posterior VMSS. Results: A much higher prevalence of VMSS was found in the TBI group (93%) compared to the non-TBI group (13%). This difference was found to be statistically significant by Chi-Square analysis (p-value of <0.0011). The directions of VMSS in the TBI group, in order of prevalence were right (82%), anterior (64%), posterior (11%), and left (7%). Chi-Square Goodness-of-Fit Test showed the prevalence of right VMSS is statistically different than left VMSS or no right/left VMSS. (p-value < 0.001) and anterior VMSS is statistically different than posterior VMSS or no anterior/posterior VMSS (p-value = 0.002). Conclusion: The prevalence of VMSS is extremely high in patients with TBI. Our study also found a much higher prevalence of right or anterior VMSS. Our data supported VMSS testing to be performed on all patients with a history of TBI.

scholarly journals Knowledge and Awareness of Turkish Population about Dental Treatment during COVID-19- A Questionnaire based Survey

2020 ◽  
Author(s):  
Ferruh Semir Smail ◽  
Mehmet Muzaffer Ate
Keyword(s):  
Dental Treatment ◽  
Statistical Significance ◽  
Turkish Population ◽  
Chi Square ◽  
Cross Sectional ◽  
First Case ◽  
Level Of Knowledge ◽  
Chi Square Analysis ◽  
Study Participants ◽  
Country Office

Introduction: SARS-CoV-2, also known as Coronavirus (COVID-19), is a zoonotic virus, which can spread from animals to humans, such as SARS-CoV and the Middle East Respiratory Syndrome (MERS-CoV) virus. The first case was reported on 31 December 2019 by the WHO Country Office in China. Aim: This study aimed to assess the knowledge and apprehension of the Turkish population about dental treatments during SARS-CoV-2. Materials and Methods: A cross-sectional questionnaire-based survey was conducted which consisted of 8 self-prepared questions with two parts. A total of 560 participants, participated in this study. Participants was selected randomly and chi-square analysis was used to analyse statistical significance difference in the response between different groups. Results: Most of the participants (80.9%) thought that their level of knowledge about coronavirus (COVID-19) was sufficient. More than half of the participants (57.2%) evaluated themselves in the risk group in the COVID-19 pandemic. A few of the participants (16.4%) had dental problems during pandemic and 83.6% did not have any dental problem. Apart from this, 53.3% of the participants think that it is not risky to have treatment with vibrating tools used in dentistry; 47.6% of the participants do not prefer to go to dentist even if they had an abscess. Conclusion: The majority of the participants thought that they were knowledgeable enough about the risks of dental treatments in the pandemic period. However, the results have shown us that further steps need to be taken to educate people about the risks of dental treatments and the necessary situations that they have to go to the dentist during this period.

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