scholarly journals Groin Abscess: Assessing The Diagnostic Accuracy Of Emergency Department Clinicians And Imaging Modalities

2020 ◽  
Vol 7 (2) ◽  
pp. 1-4
Author(s):  
Victor Ameh ◽  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Correct Diagnosis ◽  
Retrospective Chart Review ◽  
District General Hospital ◽  
Adult Patients ◽  
Provisional Diagnosis ◽  
Rare Presentation ◽  
The Right ◽  
Groin Abscess

Objective: To determine the clinical and imaging diagnostic accuracy in adult patients presenting to the Emergency Department with groin abscess. Method: Retrospective chart review of all adult patients presenting to a district general hospital with a provisional diagnosis of groin abscess was undertaken from January 2019 to December 2019. A proforma was used to capture data such as the age, sex, co-morbidities, grade of assessing clinician and imaging profile. Results: 39 patients with a provisional diagnosis of groin abscess were identified; representing approximately 1% of all ED attendances. There were 21 males and 18 females. The age range was from 23 to 73 years (mean age 42). The abscess was located on the left side in 19 patients (49%), 18 (46%) on the right and 2 (5%) were bilateral. The overall rate of correct diagnosis of the ED clinicians compared to CT diagnosis is indicated by a sensitivity of 82%, positive predictive value of 90% and an accuracy of 75%. 22 patients had CT scan which confirmed an abscess in 18 (83%). Conclusion: Groin abscess is a rare presentation to the Emergency department. Most patients were seen by clinicians below the consultant grade. Diagnostic accuracy was highest amongst physicians.

scholarly journals Diagnostic Accuracy of Neurological Problems in the Emergency Department

2008 ◽  
Vol 35 (3) ◽  
pp. 335-341 ◽  
Author(s):  
Jeremy J Moeller ◽  
Joelius Kurniawan ◽  
Gordon J Gubitz ◽  
John A Ross ◽  
Virender Bhan
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Primary Headache ◽  
Final Diagnosis ◽  
Initial Diagnosis ◽  
Educational Strategies ◽  
Diagnostic Uncertainty ◽  
Peripheral Vertigo

Background:Previous studies describe significant rates of misdiagnosis of stroke, seizure and other neurological problems, but there are few studies examining diagnostic accuracy of all emergency referrals to a neurology service. This information could be useful in focusing the neurological education of physicians who assess and refer patients with neurological complaints in emergency departments.Methods:All neurological consultations in the emergency department at a tertiary-care teaching hospital were recorded for six months. The initial diagnosis of the requesting physician was recorded for each patient. This was compared to the initial diagnosis of the consulting neurologist and to the final diagnosis, as determined by retrospective chart review.Results:Over a six-month period, 493 neurological consultations were requested. The initial diagnosis of the requesting physician agreed with the final diagnosis in 60.4% (298/493) of cases, and disagreed or was uncertain in 35.7% of cases (19.1% and 16.6% respectively). In 3.9% of cases, the initial diagnosis of both the referring physician and the neurologist disagreed with the final diagnosis. Common misdiagnoses included neurocardiogenic syncope, peripheral vertigo, primary headache and psychogenic syndromes. Often, these were initially diagnosed as stroke or seizure.Conclusions:Our data indicate that misdiagnosis or diagnostic uncertainty occurred in over one-third of all neurological consultations in the emergency department setting. Benign neurological conditions, such as migraine, syncope and peripheral vertigo are frequently mislabeled as seizure or stroke. Educational strategies that emphasize emergent evaluation of these common conditions could improve diagnostic accuracy, and may result in better patient care.

Diagnostic Accuracy of the HINTS Exam in an Emergency Department: A Retrospective Chart Review

2020 ◽  
Author(s):  
Cait Dmitriew ◽  
Aaron Regis ◽  
Oluwadamilola Bodunde ◽  
Rory Lepage ◽  
Zachary Turgeon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Chart Review ◽  
Retrospective Chart Review

scholarly journals Pseudotumor involving the distal femur – the rare presentation.

2021 ◽  
Vol 28 (10) ◽  
pp. 1531-1534
Author(s):  
Badar u Din Sahito ◽  
Masroor Ahmed ◽  
Dillep Kumar ◽  
Arsalan Khalil Ayub ◽  
Suneel Kumar ◽  
...  
Keyword(s):  
Knee Joint ◽  
Factor Viii ◽  
Distal Femur ◽  
Severe Disease ◽  
Serum Levels ◽  
Provisional Diagnosis ◽  
Range Of Movement ◽  
Rare Presentation ◽  
Factor Viii Concentrates ◽  
The Right

Pseudotumor is the rare presentation of hemophilia, and is the sign of severe disease. We present a case of 16 years old boy with no known comorbid who presented with pain and swelling around the right distal thigh for one month, his physical examination, laboratory investigation and imaging were suspicious of any malignant pathology. Biopsy was performed and specimen was sent for histopathology, that turned to be clotted blood with no atypical or malignant cells. On the basis of above findings provisional diagnosis of hemophilia was made serum levels of factor VIII were sent and that turned out to be 2.2%. Factor VIII concentrates was administered, swelling around the knee joint gradually subsided after the administration of factor VIII but there was no improvement of range of movement at knee joint.

Isolated frontosphenoidal synostosis: a rare cause of synostotic frontal plagiocephaly

2014 ◽  
Vol 13 (5) ◽  
pp. 553-558 ◽  
Author(s):  
Tina M. Sauerhammer ◽  
Albert K. Oh ◽  
Michael Boyajian ◽  
Suresh N. Magge ◽  
John S. Myseros ◽  
...  
Keyword(s):  
Demographic Data ◽  
Correct Diagnosis ◽  
Retrospective Chart Review ◽  
Ct Scanning ◽  
Ct Imaging ◽  
Radiographic Findings ◽  
Anterior Cranial Base ◽  
The Mean ◽  
Orbital Correction ◽  
The Right

Object Unilateral fusion of the frontoparietal suture is the most common cause of synostotic frontal plagiocephaly. Localized fusion of the frontosphenoidal suture is rare but can lead to a similar, but subtly distinct, phenotype. Methods A retrospective chart review of the authors' craniofacial database was performed. Patients with isolated frontosphenoidal synostosis on CT imaging were included. Demographic data, as well as the clinical and radiographic findings, were recorded. Results Three patients were identified. All patients were female and none had an identifiable syndrome. Head circumference was normal in each patient. The mean age at presentation was 4.8 months (range 2.0–9.8 months); 2 fusions were on the right side. Frontal flattening and recession of the supraorbital rim on the fused side were consistent physical findings. No patient had appreciable facial angulation or orbital dystopia, and 2 patients had anterior displacement of the ipsilateral ear. All 3 patients were initially misdiagnosed with unilateral coronal synostosis, and CT imaging at a mean age of 5.4 months (range 2.1–10.8 months) was required to secure the correct diagnosis. Computed tomography findings included patency of the frontoparietal suture, minor to no anterior cranial base angulation, and vertical flattening of the orbit without sphenoid wing elevation on the fused side. One patient underwent CT scanning at 2.1 months of age, which demonstrated a narrow, but patent, frontosphenoidal suture. The patient's condition was assumed to be a deformational process, and she underwent 6 months of unsuccessful helmet therapy. A repeat CT scan obtained at 10.7 months of age demonstrated the synostosis. All 3 patients underwent fronto-orbital correction at mean age of 12.1 months (range 7.8–16.1 months). The mean duration of postoperative follow-up was 11.7 months (range 1.9–23.9 months). Conclusions Isolated frontosphenoidal synostosis should be considered in the differential diagnosis of atypical frontal plagiocephaly.

LO07: Does point of care ultrasonography improve diagnostic accuracy in emergency department patients with undifferentiated hypotension? The first Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHOC-ED1) Study; an international randomized controlled trial

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S29
Author(s):  
M. Peach ◽  
J. Milne ◽  
D. Lewis ◽  
L. Diegelmann ◽  
H. Lamprecht ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Point Of Care ◽  
Controlled Trial ◽  
Correct Diagnosis ◽  
Diagnostic Certainty ◽  
Multicenter Rct ◽  
Significant Difference ◽  
Point Of Care Ultrasonography ◽  
The Impact

Introduction: Point of care ultrasonography (PoCUS) is an established tool in the initial management of hypotensive patients in the emergency department (ED). It has been shown rule out certain shock etiologies, and improve diagnostic certainty, however evidence on benefit in the management of hypotensive patients is limited. We report the findings from our international multicenter RCT assessing the impact of a PoCUS protocol on diagnostic accuracy, as well as other key outcomes including mortality, which are reported elsewhere. Methods: Recruitment occurred at 4 North American and 3 Southern African sites. Screening at triage identified patients (SBP<100 mmHg or shock index >1) who were randomized to either PoCUS or control groups. Scans were performed by PoCUS-trained physicians. Demographics, clinical details and findings were collected prospectively. Initial and secondary diagnoses were recorded at 0 and 60 minutes, with ultrasound performed in the PoCUS group prior to secondary assessment. Final chart review was blinded to initial impressions and PoCUS findings. Categorical data was analyzed using Fishers two-tailed test. Our sample size was powered at 0.80 (α:0.05) for a moderate effect size. Results: 258 patients were enrolled with follow-up fully completed. Baseline comparisons confirmed effective randomization. The perceived shock category changed more frequently in the PoCUS group 20/127 (15.7%) vs. control 7/125 (5.6%); RR 2.81 (95% CI 1.23 to 6.42; p=0.0134). There was no significant difference in change of diagnostic impression between groups PoCUS 39/123 (31.7%) vs control 34/124 (27.4%); RR 1.16 (95% CI 0.786 to 1.70; p=0.4879). There was no significant difference in the rate of correct category of shock between PoCUS (118/127; 93%) and control (113/122; 93%); RR 1.00 (95% CI 0.936 to 1.08; p=1.00), or for correct diagnosis; PoCUS 90/127 (70%) vs control 86/122 (70%); RR 0.987 (95% CI 0.671 to 1.45; p=1.00). Conclusion: This is the first RCT to compare PoCUS to standard care for undifferentiated hypotensive ED patients. We found that the use of PoCUS did change physicians’ perceived shock category. PoCUS did not improve diagnostic accuracy for category of shock or diagnosis.

Abstract 5588: Paramedic Activated Cath Lab For STEMI Patients At Community Hospital Meets EMS Arrival-to-Intervention Guidelines With Low False-Positive Activation Rate

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Levon Vartanian ◽  
Amilcar Avendano ◽  
Gustavo Grieco ◽  
Steve Bober ◽  
Catherine Bissell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
False Positive ◽  
Medical Center ◽  
Statistical Significance ◽  
Retrospective Chart Review ◽  
Emergency Department Physician ◽  
Mortality Data ◽  
Control Group ◽  
Activation Rate

Background: Recent ACC/AHA STEMI guidelines state “STEMI patients presenting to a hospital with PCI capability should be treated with primary PCI within 90 minutes of first medical contact.” To address this Houston Northwest Medical Center developed a STEMI protocol in 2006 with Cypress Creek EMS, its primary paramedic service, initially to decrease hospital door-to-intervention (DTI) times. System evaluation post implementation indicated that EMS arrival-to-intervention (ETI) times better reflect overall combined performance. ETI is defined as time of EMS arrival on scene to reperfusion treatment. The purpose of this study is to see if a paramedic activated cath lab for STEMI patients met guideline recommendations while maintaining a low false-positive activation rate. Methods: The initial protocol planning team determined greatest DTI reduction could be achieved through transfer of authority for cath lab activation to field paramedics. After obtaining a 12-lead ECG, paramedics notify the emergency department of a possible STEMI and the cath lab team is activated. Upon arrival, the emergency department physician obtains the ECG for interpretation and upon STEMI confirmation, the patient bypasses the emergency department and is transported directly to the cath lab. Data for protocol development was collected from a historical control group using retrospective chart review. Since protocol initiation in June 2006, ETI data is collected prospectively. Results: Between June 2006 and December 2007, 113 patients were transported utilizing the STEMI protocol. Mean hospital DTI time decreased from 121 minutes (control group) to 53 minutes (p<0.01, two-tailed t-Test). Mean ETI time is 87 minutes; Historical ETI data was not collected. 15 (13.3%) false-positive STEMI activations occurred in the study period. Diagnostic accuracy was confirmed angiographically. Mortality rate comparison did not meet statistical significance - 5.4% historical, 5.3% protocol. Conclusions: A paramedic activated cath lab for STEMI decreased DTI and ETI times to meet current guidelines. STEMI diagnostic accuracy was maintained with a low false-positive activation rate. Mortality data is insufficient for statistical significance.

scholarly journals Clinical Characteristics Associated with Return Visits to the Emergency Department after COVID-19 Diagnosis

2021 ◽  
Vol 22 (6) ◽  
pp. 1257-1261
Author(s):  
Iltifat Husain ◽  
James O'Neill ◽  
Rachel Mudge ◽  
Alicia Bishop ◽  
K. Alexander Soltany ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Characteristics ◽  
Medical Center ◽  
Multivariate Logistic Regression Analysis ◽  
Retrospective Chart Review ◽  
Adult Patients ◽  
Severe Illness ◽  
Nasopharyngeal Swab ◽  
Ed Visits ◽  
Return Visits

Introduction: Patients diagnosed with coronavirus disease 2019 (COVID-19) require significant healthcare resources. While published research has shown clinical characteristics associated with severe illness from COVID-19, there is limited data focused on the emergency department (ED) discharge population. Methods: We performed a retrospective chart review of all ED-discharged patients from Wake Forest Baptist Health and Wake Forest Baptist Health Davie Medical Center between April 25-August 9, 2020, who tested positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) from a nasopharyngeal swab using real-time reverse transcription polymerase chain reaction (rRT-PCR) tests. We compared the clinical characteristics of patients who were discharged and had return visits within 30 days to those patients who did not return to the ED within 30 days. Results: Our study included 235 adult patients who had an ED-performed SARS-CoV-2 rRT-PCR positive test and were subsequently discharged on their first ED visit. Of these patients, 57 (24.3%) had return visits to the ED within 30 days for symptoms related to COVID-19. Of these 57 patients, on return ED visits 27 were admitted to the hospital and 30 were not admitted. Of the 235 adult patients who were discharged, 11.5% (27) eventually required admission for COVID-19-related symptoms. With 24.3% patients having a return ED visit after a positive SARS-CoV-2 test and 11.5% requiring eventual admission, it is important to understand clinical characteristics associated with return ED visits. We performed multivariate logistic regression analysis of the clinical characteristics with independent association resulting in a return ED visit, which demonstrated the following: diabetes (odds ratio [OR] 2.990, 95% confidence interval [CI, 1.21-7.40, P = 0.0179); transaminitis (OR 8.973, 95% CI, 2.65-30.33, P = 0.004); increased pulse at triage (OR 1.04, 95% CI, 1.02-1.07, P = 0.0002); and myalgia (OR 4.43, 95% CI, 2.03-9.66, P = 0.0002). Conclusion: As EDs across the country continue to treat COVID-19 patients, it is important to understand the clinical factors associated with ED return visits related to SARS-CoV-2 infection. We identified key clinical characteristics associated with return ED visits for patients initially diagnosed with SARS-CoV-2 infection: diabetes mellitus; increased pulse at triage; transaminitis; and complaint of myalgias.

Development and Performance Assessment of a Digital Serious Game to Assess Multi-Patient Care Skills in a Simulated Pediatric Emergency Department

2020 ◽  
Vol 51 (4) ◽  
pp. 550-570
Author(s):  
Cindy Luu ◽  
Thomas B. Talbot ◽  
Cha Chi Fung ◽  
Eyal Ben-Isaac ◽  
Juan Espinoza ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Patient Care ◽  
Skill Acquisition ◽  
Video Game ◽  
Rank Correlation ◽  
Fixed Time ◽  
Serious Game ◽  
Cross Sectional ◽  
Number Of Patients

Objective. Multi-patient care is important among medical trainees in an emergency department (ED). While resident efficiency is a typically measured metric, multi-patient care involves both efficiency and diagnostic / treatment accuracy. Multi-patient care ability is difficult to assess, though simulation is a potential alternative. Our objective was to generate validity evidence for a serious game in assessing multi-patient care skills among a variety of learners. Methods. This was a cross-sectional validation study using a digital serious game VitalSignsTM simulating multi-patient care within a pediatric ED. Subjects completed 5 virtual “shifts,” triaging, stabilizing, and discharging or admitting patients within a fixed time period; patients arrived at cascading intervals with pre-programmed deterioration if neglected. Predictor variables included generic multi-tasking ability, video game experience, medical knowledge, and clinical efficiency with real patients. Outcome metrics in 3 domains measured diagnostic accuracy (i.e. critical orders, diagnoses), efficiency (i.e. number of patients, time-to-order) and critical thinking (number of differential diagnoses); MANOVA determined differences between novice learners and expected expert physicians. Spearman Rank correlation determined associations between levels of expertise. Results. Ninety-five subjects’ gameplays were analyzed. Diagnostic accuracy and efficiency distinguished skill level between residency trained (residents, fellows and attendings) and pre-residency trained (medical students and undergraduate) subjects, particularly for critical orders, patients seen, and correct diagnoses (p < 0.003). There were moderate to strong correlations between the game’s diagnostic accuracy and efficiency metrics compared to level of training, including patients seen (rho = 0.47, p < 0.001); critical orders (rho = 0.80, p < 0.001); time-to-order (rho = −0.24, p = 0.025); and correct diagnoses (rho = 0.69, p < 0.001). Video game experience also correlated with patients seen (rho = 0.24, p = 0.003). Conclusion. A digital serious game depicting a busy virtual ED can distinguish between expected experts in multi-patient care at the pre- vs. post-residency level. Further study can focus on whether the game appropriately assesses skill acquisition during residency.

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