There is large variation in CT ordering among EPs. Physicians' self-reported ordering rate correlates poorly with actual ordering. High CT orderers were rarely aware that they ordered more than their colleagues. Higher rates of ordering were observed among physicians who reported increased concern with 1) risk of missing a diagnosis, 2) medico-legal risk, 3) risk of contrast, 4) patient wishes, and 5) what colleagues would do.

Objectives: Computed tomography (CT) use is increasing in the emergency department (ED). Many physicians are concerned about exposing patients to radiation from CT scanning, but estimates of radiation doses vary. This study's objective was to determine the radiation doses from CT scanning for common indications in a Canadian ED using modern multidetector CT scanners. Methods: We conducted a health records review of consecutive adult patients seen at two busy tertiary care EDs over a 2-month period who underwent CT scanning ordered by emergency physicians. Cases were identified by searching an imaging database. Data collected included patient age and sex, study indication, scanner model, body area, and reported dose-length product. Effective dose per scan was calculated from reported dose-length product. Data were collected on a standardized form, entered into an electronic database, and analyzed with descriptive statistics and 95% CIs. Results: During the study period, emergency physicians assessed 19,880 patients. Overall, 2,720 (13.7%) underwent CT scanning, and of these, 144 (5.3%) patients had more than one scan. Patients had a mean age of 59.0 years, and 45.3% were men. Mean doses for the most common indications were as follows: simple head, 2.9 mSv; cervical spine, 5.7 mSv; complex head, 9.3 mSv; CT pulmonary angiogram, 11.2 mSv; abdomen (nontraumatic abdominal pain), 15.4 mSv; and abdomen (renal colic), 9.8 mSv.Conclusions: Approximately one in seven ED patients had a CT scan. Emergency physicians should be aware of typical radiation doses for the studies they order and how the dose varies by protocol and indication. RÉ SUMÉObjectif: Le recours à la tomodensitomé trie (TDM) est à la hausse dans les services d'urgence (SU), et l'exposition des patients au rayonnement des appareils de TDM pré occupe bon nombre de mé decins, mais les estimations des doses sont variables. L'é tude visait à dé terminer les doses de rayonnement é mises par des appareils modernes de TDM à dé tecteurs multiples, utilisé s dans un hô pital, au Canada, dans des indications courantes. Mé thode: Nous avons procé dé à un examen des dossiers mé dicaux d'adultes consé cutifs, qui ont é té examiné s dans deux SU de soins tertiaires, ayant une forte fré quentation, sur une pé riode de 2 mois, et qui ont subi un examen par TDM à la demande d'urgentologues. La recherche de cas s'est faite dans une base de donné es d'images. La collecte de donné es comprenait l'âge et le sexe des patients, les indications de l'examen, le modè le d'appareil, la ré gion du corps, ainsi que le produit dose-longueur indiqué . La dose efficace par balayage a é té calculé e à l'aide de ce produit dose-longueur. Les donné es ont é té recueillies sur un formulaire normalisé , inscrites dans une base de donné es é lectroniques, puis analysé es à l'aide de statistiques descriptives et d'intervalles de confiance à 95%. Ré sultats: Durant la pé riode à l'é tude, 19 880 patients ont é té examiné s par des urgentologues; 2720 (13.7%) d'entre eux ont subi une TDM, ...

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Objective:The primary objective of this study was to compare the results of nurse-performed urinalysis (NPU) interpreted visually in the emergency department (ED) with laboratory-performed urinalysis (LPU) interpreted by reflectance photometry.Methods:This was a prospective observational study based on a convenience sample from my emergency practice. Emergency nurses, who were unaware of the study, performed usual dipstick analysis before sending the same urine sample to the laboratory for testing.Results:Of 140 urinalyses performed during the study period, 124 were suitable for analysis. When compared with the reference standard LPU, the NPU had an overall sensitivity of 100% (95% confidence interval [CI] 95%–100%) and a specificity of 49% (95% CI 33%–65%) for the presence of any 1 of blood, leukocyte esterase, nitrites, protein, glucose or ketones in the urine. Of 20 falsely positive NPUs, 18 were a result of the nurse recording 1 or more components as “trace” positive.Conclusion:Although NPU does not yield identical results to LPU, a negative LPU is expected when the initial NPU in the ED is negative.