scholarly journals Adverse events are rare among adults 50 years of age and younger with flank pain when abdominal computed tomography is not clinically indicated according to the emergency physician

CJEM ◽  
2013 ◽  
Vol 15 (03) ◽  
pp. 167-174 ◽  
Author(s):  
Norman Epstein ◽  
Paul Rosenberg ◽  
Marianne Samuel ◽  
Jacques Lee
Keyword(s):  
Computed Tomography ◽  
Adverse Events ◽  
Renal Colic ◽  
Flank Pain ◽  
Adverse Outcomes ◽  
First Episode ◽  
Abdominal Ct ◽  
Abdominal Computed Tomography ◽  
Pain Patients

ABSTRACTObjective:Many emergency physicians (EPs) order “confirmatory” abdominal computed tomography (CT) in young flank pain patients, despite a high clinical suspicion of renal colic and the risk of radiation exposure. We measured the adverse outcome rate among flank pain patients identified as not requiring abdominal CT by the EP on a data form, regardless of whether CT was eventually ordered. Our secondary objective was to describe diagnoses other than renal colic identified by CT in this population.Methods:We conducted a prospective observational study at two community EDs. We asked staff EPs to complete a data sheet on patients ages 18 to 50 years with a first episode of flank pain, recording 1) if the flank pain was consistent with renal colic and 2) if the EP felt abdominal CT was indicated. Adverse outcomes (defined a priori as urgent surgical procedures, disability, or death) were assessed by research assistants at 4 weeks using telephone follow-up and a hospital records search.Results:We enrolled 389 patients; 353 completed follow-up (91%). The average age was 38.8 years, and 72.0% were male. Of 212 patients identified in the “CT not indicated” group, 2 had another diagnosis identified (unruptured diverticulitis and a ruptured ovarian cyst), but none had adverse outcomes (95% CI 0-1.4).Conclusions:Adverse events were rare (< 1.5%) among patients < 50 years old with flank pain when CT was not required according to the clinical assessment of the EP. Future research should assess the adverse outcomes of withholding CT in low-risk patients using a larger patient sample.

Outcome, complication and follow-up of patients with esophageal foreign body impaction: an academic institute’s 15 years of experience

2020 ◽  
Vol 33 (5) ◽  
Author(s):  
Seyed Farzad Marashi Nia ◽  
Mohamad Aghaie Meybodi ◽  
Richard Sutton ◽  
Ajay Bansal ◽  
Mojtaba Olyaee ◽  
...  
Keyword(s):  
Foreign Body ◽  
Adverse Events ◽  
Medical Center ◽  
Endoscopic Management ◽  
First Episode ◽  
Esophageal Foreign Body ◽  
Significant Difference ◽  
Foreign Body Impaction ◽  
Push And Pull

Summary Esophageal foreign body impaction (EFBI) is a gastrointestinal emergency, mostly requiring endoscopic management. The aim of this study is to evaluate the epidemiology, adverse events, and outcomes of patients following the episode of EFBI. All esophagogastroduodenoscopy (EGD) reports of admitted patients for EFBI at the University of Kansas Medical Center between 2003 and 2018 were retrospectively reviewed. Of 204 patients, who met the inclusion criteria, 60% were male and the mean age was 54.7 ± 17.7 years. The encounter was the first episode of EFBI in 76% of cases. EGD in less than 24 hours of patients’ admission was required in 79% of cases. The distal esophagus was the most common site of impaction (44%). Push and pull techniques were used in 38 and 35.2% of cases, respectively, while 11% were managed by a combination of both techniques. Structural causes were the most common etiologic findings including benign strictures and stenosis in 21.5% of patients, followed by Schatzki’s ring (7.8%) and hiatal hernia (6.9%). Of all cases, 45% did follow-up in up to 1 year, and biopsy was done in 34% of cases. Out of 43 patients who had endoscopic findings suspicious for eosinophilic esophagitis (EoE), the diagnosis was confirmed by pathology in 37. The rate of recurrence EFBI was significantly higher in patients with EoE (P < 0.001). EFBI-related esophageal adverse events (AEs) occurred in 4.9% of cases. Cardiovascular and pulmonary AEs occurred in 1.5 and 2.9%, respectively. Logistic regression did not find any predictor for AEs occurrence. EFBI managed very well with endoscopic treatments. Despite the emerging data about the safety of the push technique, there are still concerns regarding its adverse events especially the risk of perforations. Our study shows no significant difference in adverse events between different types of techniques.

scholarly journals Clinically significant incidental findings during preoperative computed tomography of patients undergoing cardiac surgery

2020 ◽  
Vol 31 (5) ◽  
pp. 629-631
Author(s):  
Davorin Sef ◽  
Inderpaul Birdi
Keyword(s):  
Computed Tomography ◽  
Cardiac Surgery ◽  
Incidental Findings ◽  
Preoperative Assessment ◽  
Female Gender ◽  
Ct Scans ◽  
Abdominal Ct ◽  
Clinically Significant ◽  
Work Up

Abstract With the development of minimally invasive cardiac surgery, chest and abdominal computed tomography (CT) scans are becoming an integral part of preoperative assessment and planning. Therefore, the number of incidental findings (IFs) detected with CT is rising. We aimed to investigate the frequency of clinically significant IFs on chest and abdominal CT scans performed during the preoperative assessment of patients undergoing adult cardiac surgery in a 2-year period. In a cohort of 401 patients (mean age 67.4 ± 12.3, female gender 28.9%, median logistic EuroSCORE 5.8 [0.9, 90.5]) who underwent chest or abdominal CT imaging during the study period, we identified 75 patients (18.7%) with clinically significant IFs who needed a further treatment or work-up to confirm the diagnosis or postoperative follow-up. Our data indicate that clinically significant IFs in patients referred for cardiac surgery are frequent. It is important to identify clinically significant Ifs, as a clear postoperative follow-up plan should be made.

scholarly journals Readjustment of abdominal computed tomography protocols in a university hospital: impact on radiation dose

2015 ◽  
Vol 48 (5) ◽  
pp. 292-297 ◽  
Author(s):  
Ricardo Francisco Tavares Romano ◽  
Priscila Silveira Salvadori ◽  
Lucas Rios Torres ◽  
Elisa Almeida Sathler Bretas ◽  
Daniel Bekhor ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Radiation Dose ◽  
Clinical Suspicion ◽  
University Hospital ◽  
Abdominal Ct ◽  
Abdominal Computed Tomography ◽  
Computed Tomography Scans ◽  
Group A ◽  
Group B ◽  
Tomography Scan

AbstractObjective:To assess the reduction of estimated radiation dose in abdominal computed tomography following the implementation of new scan protocols on the basis of clinical suspicion and of adjusted images acquisition parameters.Materials and Methods:Retrospective and prospective review of reports on radiation dose from abdominal CT scans performed three months before (group A – 551 studies) and three months after (group B – 788 studies) implementation of new scan protocols proposed as a function of clinical indications. Also, the images acquisition parameters were adjusted to reduce the radiation dose at each scan phase. The groups were compared for mean number of acquisition phases, mean CTDIvol per phase, mean DLP per phase, and mean DLP per scan.Results:A significant reduction was observed for group B as regards all the analyzed aspects, as follows: 33.9%, 25.0%, 27.0% and 52.5%, respectively for number of acquisition phases, CTDIvol per phase, DLP per phase and DLP per scan (p < 0.001).Conclusion:The rational use of abdominal computed tomography scan phases based on the clinical suspicion in conjunction with the adjusted images acquisition parameters allows for a 50% reduction in the radiation dose from abdominal computed tomography scans.

scholarly journals Cavernous Hemangioma of the Gallbladder Masquerading as a Carcinoma

2019 ◽  
Vol 13 (1) ◽  
pp. 219-224
Author(s):  
Naotake Funamizu ◽  
Yukio Nakabayashi
Keyword(s):  
Computed Tomography ◽  
Cavernous Hemangioma ◽  
Benign Tumors ◽  
Low Density ◽  
Vascular Endothelial ◽  
Postoperative Course ◽  
Follow Up Study ◽  
Abdominal Computed Tomography ◽  
Extended Cholecystectomy

Cavernous hemangioma arising from the gallbladder is extremely rare. Here, we report a cavernous hemangioma of the gallbladder masquerading as a carcinoma. A 75-year-old man was referred to our institution for a follow-up study after gastrectomy. Abdominal computed tomography revealed that the gallbladder was filled with a low-density mass with calcification of the wall. The patient underwent extended cholecystectomy. Histologically, the tumor consisted of vascular endothelial cellular elements and hematomas. The postoperative course was uneventful without complications. Presently, only 7 cases of cavernous hemangioma of the gallbladder have been previously reported. This case serves as an important reminder to consider benign tumors including cavernous hemangioma when investigating all possible causes of a gallbladder tumor.

scholarly journals Duodenal Perforation following Blunt Abdominal Trauma Presenting as Normal in Abdominal Computed Tomography

2014 ◽  
Vol 21 (6) ◽  
pp. 396-399 ◽  
Author(s):  
Pk Tsai ◽  
Yt Yeh ◽  
Cb Yeh
Keyword(s):  
Computed Tomography ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Life Support ◽  
Optimal Time ◽  
Advanced Trauma Life Support ◽  
Duodenal Perforation ◽  
Abdominal Ct ◽  
Abdominal Computed Tomography ◽  
Repeat Examination

Most emergency department (ED) physicians implement the Advanced Trauma Life Support (ATLS) approach, including primary and secondary survey, for the assessment of blunt abdominal trauma (BAT) patients. This report emphasizes the need for repeat Focused Assessment with Sonography for Trauma (FAST) and abdominal computed tomography (CT) if a BAT patient's condition persists or worsens. After initial negative FAST and abdominal CT findings, it is recommended that BAT patients with suspected intraabdominal injury should receive repeat examination in an optimal time. We report a patient who sustained duodenal perforation following BAT diagnosed by repeat ultrasound examination and abdominal CT scan. (Hong Kong j.emerg.med. 2014;21:396-399)

The Use of Abdominal Computed Tomography Imaging Technology in the Treatment of Surgical Acute Abdominal Perforation

2020 ◽  
Vol 10 (9) ◽  
pp. 2130-2135
Author(s):  
Yong Liu ◽  
Tuo Su ◽  
Ping Wei ◽  
Wei Han ◽  
Zhili Ji
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Diagnostic Value ◽  
Imaging Features ◽  
Abdominal Ct ◽  
Imaging Technology ◽  
Abdominal Computed Tomography ◽  
Specific Sign ◽  
Suspected Acute Appendicitis ◽  
Image Performance

Objective: The objective of this study is to explore the imaging features of abdominal Computed Tomography (CT) in patients with surgical acute abdominal perforation and to improve the diagnostic ability of perforated acute appendicitis (PAA). Method: Patients with suspected acute appendicitis and abdominal pain are selected as the study objects. According to the surgical records and pathological results, the patients are divided into PAA group and nonperforated acute appendicitis (NPAA) group. All patients are examined by abdominal CT. Postprocessing reconstruction technology such as multiple planar reconstruction (MPR) algorithm and curved planar reformat (CPR) algorithm are used as assistance to display the appendix, analyze and compare the images, observe the image performance of abdominal CT, and measure the diameter of the appendix. Results: The incidence of PAA specific signs (i.e. cellulitis around the appendix, abscess around the appendix, enhancement defect of the appendix wall, air accumulation outside the appendix cavity, fecal stone outside the appendix cavity) in PAA group is significantly higher than that in NPAA group (P < 0.05). Appearance of at least one specific sign for the diagnosis of PAA is 95.65%, the specificity is 92.59%, and the accuracy is 94.00%. The diameter of appendix in PAA group is significantly larger than that in NPAA group (P < 0.05). Compared with the diagnosis of simple specific signs, the specificity and accuracy of the combination of appendiceal diameter and specific signs in the diagnosis of PAA have been improved. Conclusion: With the help of MPR algorithm and CPR algorithm, abdominal CT imaging technology can accurately identify PAA and NPAA, which has important diagnostic value.

P2853Contemporary reporting of acute complications from implantable cardioverter defibrillator surgery

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Hassan ◽  
D Birnie ◽  
P Nery ◽  
G Nair ◽  
D Davis ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pulse Generator ◽  
De Novo ◽  
Care Center ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Physician Remuneration ◽  
Major Adverse Events ◽  
Lead Dislodgement

Abstract Background Defibrillator placement carries an inherent risk to the patient. Traditionally, major adverse events defined as cardiac arrest, tamponnade, pneumothorax, infection requiring re-operation, MI and CVA within 30 days are reported to occur between 3 and 4%. Minor complications such as heamatomae or lead dislodgement are reported between 8 and 13%. Novel lead technologies, protocolised programming and reduced use of Heparin bridging have been reported to reduce adverse outcomes. However, patients are still typically monitored in hospital for 24 hours to mitigate these risks. There is little evidence that discharge delay is effective yet incurs significant additional costs. Purpose We sought to evaluate the frequency and timing of adverse events relating to defibrillator surgery (ICD and CRT-D) at a large Canadian tertiary care center (UOHI). Methods We retrospectively reviewed all patients who received a defibrillator placed from 1st April 2013 to 31st March 2018 inclusive. Patient comorbidities were extracted from the hospital electronic medical record (EMR) system. Device related information and complications were extracted from UOHI PaceartTM system and EMR and cross referenced with physician remuneration databases. Results A total of 2221 procedures were performed on 2153 patients (78% male, mean age 65 years). The majority (60%) of defibrillator implants were de novo, with 884 (40%) pulse generator replacements/ upgrades and 868 (39%) defibrillators had CRT capability. Patients were routinely discharged within 24 hours of ICD surgery. Post-operative follow up ≥30 days was complete in 97% patients. Major adverse events occurred within 30 days in 9 patients (0.4%); 9 (100%) were infection requiring re-operation. An additional 32 patients (1.5%) required repeat interventions or readmission within 30 days of implant, most commonly due to lead dislodgement. Only 2 patients required readmission within 24 hours of surgery (0.1%). All procedure-related adverse events during clinical follow up (≤5 years) were 131 (5.9%) occurring in 122 patients. There were no apparent predictors of adverse events in this cohort. Conclusion(s) Contemporary risks to patients undergoing defibrillator surgery are considerably lower than that reported in 2010. The risk of infection appears constant despite increased antibiosis. Patients receiving an ICD or CRT-D can safely be discharged within 24 hours if no complications are apparent. Acknowledgement/Funding None

Abstract 14733: Influence of High Risk Adrenergic Receptor Genotypes on Outcome in Infants With Single Ventricle

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ronand Ramroop ◽  
Dorin Manase ◽  
George Manase ◽  
Cory Simmons ◽  
Jane W Newburger ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Outcomes ◽  
Confidence Intervals ◽  
Adrenergic Receptor ◽  
Single Ventricle ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Serious Adverse Events ◽  
Free Survival

Introduction: Variants in adrenergic receptor (ADR) genes are associated with adverse clinical outcomes in patients with heart failure. We evaluated the association of variants in ADR receptor genes with outcomes in infants with single ventricle lesions. Methods: Infants with single ventricle lesions participating in the Pediatric Heart Network Single Ventricle Reconstruction Trial (randomized to Norwood with modified Blalock-Taussig shunt versus right ventricle-pulmonary artery shunt) underwent genotyping for 4 single nucleotide polymorphisms (SNPs) in 3 ADR genes: ADRB1-A/G (rs1801252), ADRB1-C/G (rs1801253), ADRB2-C/G (rs1042714) and ADRA2A-C/T (rs553668). Linear and logistic regression, deviance tests, t-tests and F-tests were used to analyze association of genotype with clinical outcomes including hospital length of stay (LOS) at Norwood, occurrence of serious adverse events (SAE), and transplant-free survival during 14 months follow-up using a dominant model. Results: The study included 347 eligible patients (62% male; 83% white). The mean age at Norwood procedure was 6±3.6 days and median Norwood LOS was 8 days. During 14 months follow-up, 147 patients had SAEs, 94 patients died and 14 were transplanted. ADRB1 AA (rs1801252) genotype was associated with longer Norwood LOS. The difference in LOS between AA vs AG/GG was 7.99 days (confidence intervals, 0.27, 15.71; p=0.043). ADRA2A CC (rs553668) genotype was associated with higher odds of SAEs i.e. 103/216 (47.6%) in CC compared to 36/106 (34%) in CT/TT [Odds ratio 1.77 (confidence intervals, 1.09, 2.87), p=0.018]. Transplant-free survival was not different between genotype groups. Combined analysis of risk genotypes did not confer an additive risk of adverse outcomes. Conclusions: ADR genotypes known to cause adrenergic upregulation were associated with prolonged Norwood hospitalization and/or serious adverse events in infant single ventricles. This may be secondary to adverse effects of adrenergic overexpression on cardiac function and systemic hemodynamics. Analysis is ongoing to replicate these findings for utility as predictive markers for outcomes in infant single ventricles.

The value of 64-detector row computed tomography for the exclusion of pulmonary embolism

2011 ◽  
Vol 105 (05) ◽  
pp. 901-907 ◽  
Author(s):  
Giorgio de Conti ◽  
Isabella Minotto ◽  
Lucia Filippi ◽  
Marta Mongiat ◽  
Daniele de Faveri ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Clinical Decision ◽  
First Episode ◽  
Diagnostic Strategy ◽  
Clinical Disorder ◽  
Vein Thrombosis ◽  
Test Probability ◽  
D Dimer

SummaryRecently, a diagnostic strategy using a clinical decision rule, D-dimer testing and spiral computed tomography (CT) was found to be effective in the evaluation of patients with clinically suspected pulmonary embolism (PE). However, the rate of venous thromboembolic complications in the three-month follow-up of patients with negative CT was still substantial and included fatal events. It was the objective to evaluate the safety of withholding anticoagulants after a normal 64-detector row CT (64-DCT) scan from a cohort of patients with suspected PE. A total of 545 consecutive patients with clinically suspected first episode of PE and either likely pre-test probability of PE (using the simplified Wells score) or unlikely pre-test probability in combination with a positive D-dimer underwent a 64-DCT. 64-DCT scanning was inconclusive in nine patients (1.6%), confirmed the presence of PE in 169 (31%), and ruled out the diagnosis in the remaining 367. During the three-month follow-up of the 367 patients one developed symptomatic distal deep-vein thrombosis (0.27%; 95%CI, 0.0 to 1.51%) and none developed PE (0 %; 95%CI, 0 to 1.0%). We conclude that 64-DCT scanning has the potential to safely exclude the presence of PE virtually in all patients presenting with clinical suspicion of this clinical disorder.

Abstract 1122‐000088: Vertebral Origin Stenting Appears Safe and is Associated with Improved Functional Outcome at 3 Months

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Milagros Galecio‐Castillo ◽  
Milagros Galecio‐Castillo ◽  
Mudassir Farooqui ◽  
Kara Christopher ◽  
Cynthia B Zevallos ◽  
...  
Keyword(s):  
Adverse Events ◽  
Vertebral Artery ◽  
Stent Migration ◽  
Adverse Outcomes ◽  
Posterior Circulation ◽  
Cerebellar Infarction ◽  
Vascular Territory ◽  
Permanent Disability ◽  
Tandem Stenosis

Introduction : Stenosis of the vertebral artery origin (VAOS), while under‐diagnosed, is common and may cause up to 25% of posterior circulation infarctions. Stenting is widely employed as a secondary prevention strategy, but clinical studies of safety and efficacy are limited compared to carotid interventions. Methods : This is a retrospective observational cohort study of subjects who underwent vertebral origin stenting at two large academic centers. The demographic profile of the subjects, medical comorbidities, and radiological parameters were all collected. Primary safety outcome was defined as 30‐day post‐procedure complications. Secondary safety outcomes included periprocedural complications and change in the pre‐procedure Modified Rankin score (mRS) at 3 months of follow‐up. Results : There were 80 subjects who underwent vertebral artery stenting in this cohort. Mean age was 66.6 +10.2 years, 72.5% (n = 58) were male, 70% (n = 56) were Caucasian. 53.8% (n = 43) were treated for the right VA, 72.5% (n = 58) received second‐generation drug‐eluting stents (DES). Hypertension 67.5% (n = 54) and hyperlipidemia 65% (n = 52) were the most prevalent vascular risk factors. 76.3% (m = 61) of subjects were symptomatic at presentation. There were 8 adverse events identified at 30 days (10%): 3 strokes in the same vascular territory (2 minor and without permanent disability), 1 stroke in a different vascular territory, 2 subjects with worsening of symptoms attributable to the posterior circulation, 1 GI bleed, and 1 femoral thrombosis. 3 of these subjects were found to have ipsilateral tandem stenosis and 1 patient died due to distal occlusion and large cerebellar infarction. There were 4 (5%) adverse events identified in the immediate periprocedural period: 1 vertebral dissection, 1 in‐stent thrombosis, 1 SCA embolism, and 1 stent migration. mRS of these patients remained the same at 30 days and 3 months of follow‐up. Overall, the Modified Rankin score was significantly lower at 3 months versus the pre‐procedure (Z = ‐2.45, p = 0.01). Conclusions : This large cohort of subjects undergoing vertebral origin stenting demonstrates a low incidence of procedural complications and adverse outcomes at 30 days. mRS was significantly lower at 3 months. While disability seemed to decrease in this population, longer prospective efficacy endpoints are needed to better evaluate this therapy.

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