The Positive Impact on Emergency Department Length of Stay of a Clinical Practice Guideline-Directed Process for Direct Admission from the Emergency Department Computed Tomography Scan Suite to the Intensive Care Unit of Highest Level Trauma Activation Patients

Background Currently, there are limited data available describing the long-term outcomes of chest trauma survivors. Here, the authors sought to describe chest trauma survivor outcomes 6 months and 1 yr after discharge from the intensive care unit, paying special attention to pulmonary outcomes. Methods A cohort of 105 multiple trauma patients with blunt chest trauma admitted to the intensive care unit was longitudinally evaluated. After 6 months, a chest computed tomography scan, pulmonary function testing (PFT), and quality of life were collected in 55 of these patients. A subgroup of 38 patients was followed up for 1 yr. Results At least one abnormal PFT result was found in 39 patients (71%). Compared with normalized data of the age- and sex-matched population, physical function was decreased in 38 patients (70%). The 6-min walk distance was reduced for 29 patients (72%). Although pathologic images were observed on the chest computed tomography scan from 33 patients (60%), no relation was found between PFT and computed tomography. A ratio of arterial oxygen pressure to inspired oxygen fraction less than 200 at admission to the intensive care unit predicted an abnormal PFT result at 6 months. One year after discharge from the intensive care unit, paired comparisons showed a significant increase in forced vital capacity (P = 0.02) and Karnofsky Performance Status (P < 0.001). Conclusions Survivors of multiple traumas including chest trauma demonstrate a persistent decrease in the 6-min walk distance, impairment on PFT, and reduced pulmonary-specific quality of life.

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Pneumocephalus and pneumorachis after blunt chest trauma without spinal fractures: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2208-3 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 1

Author(s):

Etienne Allard ◽

Jean Selim ◽

Benoit Veber

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care ◽

Case Report ◽

Blunt Trauma ◽

Subcutaneous Emphysema ◽

Spinal Canal ◽

Skull Fractures ◽

Computed Tomography Scan ◽

Tomography Scan

Abstract Background Pneumocephalus and pneumorachis, presence of air inside the skull and spinal canal, are mostly seen after neurosurgical procedures and neuraxial anesthesia. They have also been described after penetrating trauma, but never after blunt trauma without adjacent bone fractures. Case description We present the case of an 85-year-old white male patient admitted to our intensive care unit after a high velocity car accident. On site clinical evaluation showed normal consciousness with 15/15 Glasgow Coma Scale after a short initial loss of consciousness. The patient was first sent to a nearby hospital where a whole-body computed tomography scan revealed pneumocephalus and pneumorachis and an important left hemopneumothorax with pneumomediastinum with extensive subcutaneous emphysema. The state of the patient quickly worsened with hemorrhagic shock. The patient was sent to our intensive care unit; upon neurosurgical evaluation, no surgical indication was retained due to the absence of skull and spine fracture. A computed tomography scan performed on day 6 showed total regression of the pneumocephalus and pneumorachis. A follow-up computed tomography scan performed on day 30 revealed no intracranial bleeding or stroke, but a left pleural hernia between ribs 5 and 6. Due to respiratory complications, our patient could not be weaned from ventilator support for a proper neurological examination. Our patient’s state finally worsened with septic shock due to ventilator-acquired pneumonia leading to multiple organ failure and our patient died on day 37. Conclusions This is the first case report to describe pneumorachis and pneumocephalus following blunt trauma with pneumothorax, but no spinal or skull fractures. The mechanism that is probably involved here is a migration of air with subcutaneous emphysema and a pleural hernia into the spinal canal. However, in cases of pneumorachis or pneumocephalus, skull fractures need to be investigated as these require surgery and appropriate vaccination to prevent meningitis.

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Occult Pulmonary Embolism in Intensive Care Unit Patients Undergoing Chest Computed Tomography Scan: Incidence and Effect on Outcomes

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2012.10.015 ◽

2013 ◽

Vol 27 (3) ◽

pp. 474-478 ◽

Cited By ~ 2

Author(s):

Elodie Arnoult ◽

Sandrine Wiramus ◽

Julien Textoris ◽

Fabien Craighero ◽

Benoit Ragonnet ◽

...

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Pulmonary Embolism ◽

Intensive Care ◽

Computed Tomography Scan ◽

Chest Computed Tomography ◽

Tomography Scan

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What are the head computed tomography scan rates in children presenting with headache to an Australian community teaching hospital emergency department?

Pediatric Emergency Medicine Journal ◽

10.22470/pemj.2019.00024 ◽

2019 ◽

Vol 6 (1) ◽

pp. 31-33

Author(s):

Sharon Klim ◽

David Krieser ◽

Anne-Maree Kelly

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Teaching Hospital ◽

Hospital Emergency Department ◽

Computed Tomography Scan ◽

Hospital Emergency ◽

Australian Community ◽

Head Computed Tomography ◽

Tomography Scan ◽

Community Teaching

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Noninvasive Ventilation Initiation in Clinical Practice: A Six-Year Prospective, Observational Study

Canadian Respiratory Journal ◽

10.1155/2010/842543 ◽

2010 ◽

Vol 17 (3) ◽

pp. 123-131 ◽

Cited By ~ 2

Author(s):

Chris Harris ◽

Refik Saskin ◽

Karen EA Burns

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Clinical Practice ◽

Observational Study ◽

Noninvasive Ventilation ◽

Prospective Observational Study ◽

Obstructive Sleep ◽

Positive Airway Pressure Ventilation ◽

Over Time

BACKGROUND: Despite evidence supporting the role of noninvasive ventilation (NIV) in diverse populations, few publications describe how NIV is used in clinical practice.OBJECTIVE: To describe NIV initiation in a teaching hospital that has a guideline, and to characterize temporal changes in NIV initiation over time.METHODS: A prospective, observational study of continuous positive airway pressure ventilation (CPAP) or bilevel NIV initiation from January 2000 to December 2005 was conducted. Registered respiratory therapists completed a one-page data collection form at NIV initiation.RESULTS: Over a six-year period, NIV was initiated in 623 unique patients (531 bilevel NIV, 92 CPAP). Compared with bilevel NIV, CPAP was initiated more often using a nasal interface, with a machine owned by the patient, and for chronic conditions, especially obstructive sleep apnea. Whereas CPAP was frequently initiated and continued on the wards, bilevel NIV was most frequently initiated and continued in the emergency department, intensive care unit and the coronary care unit. Patients initiated on bilevel NIV were more likely to be female (OR 1.8, 95% CI 1.08 to 2.85; P=0.02) and to have an acute indication compared with CPAP initiations (OR 7.5, 95% CI 1.61 to 34.41; P=0.01). Bilevel NIV was initiated more often in the emergency department than in the intensive care unit (OR 5.8, 95% CI 0.89 to 38.17; P=0.07). Bilevel NIV initiation increased from 2000 to 2005.CONCLUSIONS: The present study illustrates how NIV is used in clinical practice and confirms that NIV initiation has increased over time.

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Computed Tomography Scan Use in the Emergency Department Evaluation of Patients with Nonspecific Abdominal Pain Is Increasing Despite Decreased Patient Acuity

Academic Emergency Medicine ◽

10.1197/j.aem.2005.03.208 ◽

2005 ◽

Vol 12 (Supplement 1) ◽

pp. 75-75 ◽

Cited By ~ 1

Author(s):

J. Brown

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Abdominal Pain ◽

Computed Tomography Scan ◽

Patient Acuity ◽

Department Evaluation ◽

Tomography Scan

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Prediction Score for Cervical Spine Fracture in Patients with Traumatic Neck Injury

Neurology Research International ◽

10.1155/2021/6658679 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Natsinee Athinartrattanapong ◽

Chaiyaporn Yuksen ◽

Sittichok Leela-amornsin ◽

Chetsadakon Jenpanitpong ◽

Sirote Wongwaisayawan ◽

...

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Cervical Spine ◽

Spine Fracture ◽

Prediction Score ◽

Spine Injury ◽

Cervical Spine Fracture ◽

Clinical Prediction ◽

Computed Tomography Scan ◽

Tomography Scan

Background. Cervical spine fracture is approximately 2%–5%. Diagnostic imaging in developing countries has several limitations. A computed tomography scan is not available 24 hours and not cost-effective. This study aims to develop a clinical tool to identify patients who must undergo a computed tomography scan to evaluate cervical spine fracture in a noncomputed tomography scan available hospital. Methods. The study was a diagnostic prediction rule. A retrospective cross-sectional study was conducted between August 1, 2016, and December 31, 2018, at the emergency department. This study included all patients aged over 16 years who had suspected cervical spine injury and underwent a computed tomography scan at the emergency department. The predictive model and prediction scores were developed via multivariable logistic regression analysis. Results. 375 patients met the criteria. 29 (7.73%) presented with cervical spine fracture on computed tomography scan and 346 did not. Five independent factors (i.e., high-risk mechanism of injury, paraparesis, paresthesia, limited range of motion of the neck, and associated chest or facial injury) were considered good predictors of C-spine fracture. The clinical prediction score for C-spine fracture was developed by dividing the patients into three probability groups (low, 0; moderate, 1–5; and high, 6–11), and the accuracy was 82.52%. In patients with a score of 1–5, the positive likelihood ratio for C-spine fracture was 1.46. Meanwhile, those with a score of 6–11 had an LR+ of 7.16. Conclusion. In a noncomputed tomography scan available hospital, traumatic spine injuries patients with a clinical prediction score ≥1 were associated with cervical spine fracture and should undergo computed tomography scan to evaluate C-spine fracture.

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