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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Emergency department chest and abdominal computed tomography: impact on patients’ management

Abstract

Objective. The introduction of computed tomography (CT) has had a very significant impact on patient evaluation and management decisions in the Emergency Department (ED). One of the few published studies demonstrated a positive CT yield in 67% of patients admitted to hospital. The same study demonstrated that in 25% of cases, the CT examination was able to identify a pathological process unidentified by the ED team. Only one study has focused on the evaluation of the variation in patient management that each CT examination is able to achieve. The purpose of our study is to document the impact that CT has on patient diagnosis and management in the ED, employing a large patient series.

Materials and methods. The diagnostic and therapeutic impact of CT was evaluated in a consecutive series of 300 patients who were referred to the radiology department for a chest or abdominal CT examination as requested by the emergency physician.

Results. The net impact of performing a CT was a change in planned treatment in 202 cases out of 300 (67%) and proceding with the planned treatment in the remaining 98 cases (33%). The only intention to demand a CT examination was significantly bound (p=0.015, confidence interval 0.16 and 0.38) to a change in the planned treatment before CT (as it is established with Mc Nemar test).

Discussion. Our study showed that more than 67% of CT reports were able to change the course of treatment planned before CT execution and that in 56% of these cases, the execution of a CT examination was able to generate a major variation in treatment plan.

Key words: emergency department, computed tomography, chest, abdomen, clinical impact

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Radiation exposure from computed tomography in blunt trauma patients

Abstract

Introduction. Computed tomography (CT) has many diagnostic advantages, spurring growth in the number of CT examinations. As the use of CT increases, the potential for radiation-induced adverse effects has become an issue. The primary objective of this study was to assess the liberal use of CT induced radiation exposure in patients with multiple blunt traumas. The secondary objective was to investigate the factors affecting the estimated effective dose resulting from CTs unrelated to final diagnosis.

Methods. Using data from our hospital information system, we selected patients assigned a trauma code, according to the Korean Standard Classification of Diseases, and with three or more body lesions assessed by CT at the same time in the emergency department. Each CT conducted was categorized into ‘CT related to the final diagnosis’ or ‘CT unrelated to final diagnosis’. The characteristics and estimated effective dose of CTs unrelated to the final diagnosis were analyzed. The factors affecting the estimated effective dose of CTs unrelated to final diagnosis were investigated.

Results. More than half of all CT examinations were not associated with the final diagnosis. The additional estimated effective dose due to CTs being unrelated to the final diagnosis in each patient was a sufficient amount of radiation exposure to increase the possibility of fatal cancer.

Conclusion. A considerable number of CT scans were unrelated to the patient’s final diagnosis, which exposes the patient to additional radiation exposure.

Key words: radiation, trauma, computed tomography

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Internal carotid artery dissection at the supraclinoid portion after severe traumatic head injury in a child

Abstract

A 14-year-old boy with severe traumatic brain injury (TBI) and cranial fractures was admitted to our emergency department after a motor vehicle accident. An emergency craniotomy was performed, and traumatic carotid artery (CA) dissection (tCAD) was revealed by cerebral angiography. The patient then underwent close observation in the intensive care unit. Traumatic CADs are difficult to diagnose in the early period after injury, and are associated with serious problems and a high mortality rate. There is still a lack of knowledge surrounding its natural history and treatment options, especially in children. Moreover, it commonly occurs at the cervical internal CA, and tCAD at the supraclinoid portion is quite rare. To the best of our knowledge, this is the first report accompanied by radiological images of the clinical course of tCAD at the supraclinoid portion following severe TBI in a child.

Key words: traumatic brain injury, craniotomy, neurosurgery, computed tomography, angiography.

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