CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making

Pandharipande, Pari V.; Reisner, Andrew; Binder, William; Zaheer, Atif; Gunn, Martin L.; Linnau, Ken F.; Miller, Chad M.; Avery, Laura L.; Herring, Maurice; Tramontano, Angela C.; Dowling, Emily C.; Abujudeh, Hani H.; Eisenberg, Jonathan D.; Halpern, Elkan F.; Donelan, Karen; Gazelle, G. Scott

doi:10.1148/radiol.2015150473

Cited by 108 publications

(77 citation statements)

References 24 publications

(30 reference statements)

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Section: For the Proposition: Jeffry A Siegel Phdmentioning

confidence: 99%

“…Moreover, imaging's dual benefits remain hidden: first, the valuable diagnostic information it provides, which either strengthens confidence in suspected diagnoses or leads to more accurate diagnoses and better treatments; 7 and second, the far more likely low-dose health benefits of reduced lifetime cancer risk and all-cause mortality. 8 Medical imaging achieves a diagnostic purpose and should be governed by the highest science-based principles and policies (use of proper procedures, appropriately calibrated equipment, etc.).…”

Section: Opening Statementmentioning

confidence: 99%

See 1 more Smart Citation

Advocating for use of the ALARA principle in the context of medical imaging fails to recognize that the risk is hypothetical and so serves to reinforce patients' fears of radiation

Siegel

McCollough

Orton³

2017

Medical Physics

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Section: For the Proposition: Jeffry A Siegel Phdmentioning

confidence: 99%

Section: Opening Statementmentioning

confidence: 99%

Advocating for use of the ALARA principle in the context of medical imaging fails to recognize that the risk is hypothetical and so serves to reinforce patients' fears of radiation

Siegel

McCollough

Orton³

2017

Medical Physics

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“…Es considerada un agente carcinogénico dosisdependiente, capaz de transferir energía altamente estructurada de eventos de ionización y excitación que pueden producir daños complejos al ADN, tales como lesión en bases simples, alteraciones monocatenarias en el esqueleto del ADN, rotura del ADN bicatenario, aberraciones cromosómicas, cambios celulares, mutaciones y muerte celular (8)(9)(10) . La Agencia Internacional para la Investigación del Cáncer (IARC), clasifica la radiación ionizante como carcinogénico del grupo 1, con alto riesgo de producir neoplasias que comprometen principalmente el tegumento, tiroides, cerebro, mamas y sangre, no sólo por la exposición ambiental sino por el efecto iatrogénico por el uso en métodos diagnósticos y tratamiento contra neoplasias (11)(12)(13) .…”

Section: Radiación Ionizanteunclassified

Carcinógenos ambientales asociados a cáncer infantil

et al. 2019

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Introducción: La Sociedad Americana de Cáncer indica que al año se diagnostican 163.300 casos de cáncer infantil en el mundo. En Colombia fueron reportadas 300 muertes por esta causa en menores de edad durante el año 2015. Actualmente, las principales asociaciones etiológicas de cáncer infantil son la radiación ionizante y exposición a pesticidas, convirtiéndose en una prioridad emergente en la agenda mundial de salud infantil. Objetivo: Identificar factores carcinogénicos asociados al incremento de riesgo en la aparición de cáncer infantil. Materiales y métodos: Se realizó una revisión de artículos científicos en inglés y español en la base de datos PubMed, ScienceDirect, SciELO, y publicaciones estadísticas de la Organización Mundial de la Salud, Asociación Americana de Cáncer y el Instituto Nacional de Cancerología de Colombia. Resultados: Se describieron diferentes factores carcinogénicos como radiación ionizante, agentes biológicos, patrones dietéticos, exposición a pesticidas, tabaco y asbesto, destacando su asociación en el desarrollo de cáncer infantil. Conclusión: El reconocimiento de los agentes carcinogénicos frecuentemente asociados con cáncer infantil, permite identificar el impacto de estos sobre la salud, y generar medidas preventivas más eficaces que puedan reducir la carga global de la enfermedad.

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“…The Computed Tomography (CT) has great accuracy in the evaluation of most urgent abdominal diseases, surpassing the performance of ultrasonography (US) and conventional x-ray (RX) 1,2 and, therefore, it has been increasingly used in evaluation of patients with acute abdominal pain (AAP) 3,4 . Its introduction in the emergency room (ER) has been associated with increased confidence in the diagnosis and improved medical decision-making 5 . In Brazil, the total number of CT procedures increased from 540,067 to 921,485 exams between 2008 and 2011 in the Brazilian Unified Health System (SUS -Sistema Único de Saúde), with abdominal and pelvic CTs being the second most often performed ones 6 .…”

Section: Introductionmentioning

confidence: 99%

Abdominal Computed Tomography in the Emergency Room: Overuse of Medical Technologies and the Depreciation of Clinical Diagnosis

Silva

Oliveira

Prado

et al. 2019

Rev. bras. educ. med.

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The number of computed tomography (CT) examinations performed in urgent care has been increasing since its introduction in the emergency room (ER). This has led to a substantial increase in hospital costs and patient’s exposure to ionizing radiation, which has led to the need for more judicious use of CT in the ER. The aim of this study is to show the difference between clinical (pre-CT), tomographic (post-CT) and definitive diagnoses in patients with abdominal CT in the ER. This is a cross-sectional study, with retrospective data collection through electronic medical records. A total of 834 patients with acute abdominal pain (AAP) lasting less than 7 days, submitted to abdominal computed tomography between January 1, 2016 and December 31, 2017 were selected. Clinical, tomographic and final diagnoses were recorded and submitted to a concordance analysis by calculating the Kappa coefficient, considering p <0.05 as significant. CT scans were considered unnecessary when the clinical diagnosis was concordant when both final and post-CT diagnosis were also concordant. The most frequent diagnoses were nonspecific abdominal pain (NSAP), obstructive uropathy (OU) and appendicitis (AP), corresponding to 73.6%, 58.5% and 61.3% of all diagnoses, respectively. Data analysis showed a moderate Concordance for NSAP (kappa: 0.41, p ¬<0.001) and for OU (kappa: 0.46, p <0.001) and excellent for AP (kappa:0.87, p <0.001). In total, 52.6% of computed tomography were considered unnecessary for NSAP, 82.4% for OU and 91.7% for AP. It was concluded that there are high rates of CT that may be considered unnecessary for the diagnosis of the main emergency conditions, especially appendicitis. The study warns to the exaggerated use of CT in the ER and raise discussions over the possible causes, such as lack of confidence in the clinical diagnosis, fear of diagnostic errors and fear of malpractice lawsuits, of which possible solutions may be more effective when applied since the medical education basis.

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CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making

Abstract: Physicians' diagnoses and admission decisions changed frequently after CT, and diagnostic uncertainty was alleviated.

Cited by 108 publications

References 24 publications

Advocating for use of the ALARA principle in the context of medical imaging fails to recognize that the risk is hypothetical and so serves to reinforce patients' fears of radiation

Advocating for use of the ALARA principle in the context of medical imaging fails to recognize that the risk is hypothetical and so serves to reinforce patients' fears of radiation

Carcinógenos ambientales asociados a cáncer infantil

Abdominal Computed Tomography in the Emergency Room: Overuse of Medical Technologies and the Depreciation of Clinical Diagnosis

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