Radiation doses to emergency department patients undergoing computed tomography

Worrall, J.; Jama, Sadia; Stiell, Ian G.

doi:10.1017/s1481803500003493

Cited by 12 publications

(6 citation statements)

References 34 publications

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“…The estimated radiation doses of all performed CT examinations in this study were below national diagnostic reference levels. Worall et al reported radiation doses for 2720 emergency department patients undergoing CT (26). In comparison, the median estimated radiation doses in our study were almost equal for cranial CT (2.6 versus.…”

Section: Discussioncontrasting

confidence: 53%

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Incidence of combined cranial and cervical spine injuries in patients with blunt minor trauma: are combined CT examinations of the head and cervical spine justified?

et al. 2016

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Background The use of computed tomography (CT) scans of the head and cervical spine has markedly increased in patients with blunt minor trauma. The actual likelihood of a combined injury of head and cervical spine following a minor trauma is estimated to be low. Purpose To determine the incidence of such combined injuries in patients with a blunt minor trauma in order to estimate the need to derive improved diagnostic guidelines. Material and Methods A total of 1854 patients were retrospectively analyzed. All cases presented to the emergency department and in all patients combined CT scans of head and cervical spine were conducted. For the following analysis, only 1342 cases with assured blunt minor trauma were included. Data acquisition covered age, sex, and presence of a head injury as well as presence of a cervical spine injury or both. Results Of the 1342 cases, 46.9% were men. The mean age was 65.6 years. CT scans detected a head injury in 116 patients; of these, 70 cases showed an intracranial hemorrhage, 11 cases a skull fracture, and 35 cases an intracranial hemorrhage as well as a skull fracture. An injury of the cervical spine could be detected in 40 patients. A combined injury of the head and cervical spine could be found in one patient. Conclusion The paradigm of the coincidence of cranial and cervical spine injuries should be revised in patients with blunt minor trauma. Valid imaging decision algorithms are strongly needed to clinically detect high-risk patients in order to save limited resources.

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Section: Discussioncontrasting

confidence: 53%

“…Worall et al. reported radiation doses for 2720 emergency department patients undergoing CT (26). In comparison, the median estimated radiation doses in our study were almost equal for cranial CT (2.6 versus.…”

Section: Discussionmentioning

confidence: 99%

Incidence of combined cranial and cervical spine injuries in patients with blunt minor trauma: are combined CT examinations of the head and cervical spine justified?

et al. 2016

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“…Pulmonary embolism (PE) can be life-threatening and, when suspected, is usually investigated by computed tomographic pulmonary angiogram (CTPA). Concerns related to overutilization and harmful ionizing radiation have identified CTPA as an area in need of resource stewardship . The purpose of this study was to explore interphysician variability in CTPA diagnostic yield and to identify any associated physician characteristics that could inform an intervention to reduce overuse in our institution.…”

mentioning

confidence: 99%

Association of Lower Diagnostic Yield With High Users of CT Pulmonary Angiogram

et al. 2018

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Pulmonary embolism (PE) can be life-threatening and, when suspected, is usually investigated by computed tomographic pulmonary angiogram (CTPA). Concerns related to overutilization and harmful ionizing radiation have identified CTPA as an area in need of resource stewardship. 1,2 The purpose of this study was to explore interphysician variability in CTPA diagnostic yield and to identify any associated physician characteristics that could inform an intervention to reduce overuse in our institution.Methods | We retrospectively reviewed all CTPAs at an academic teaching hospital in Montreal, Quebec, Canada, from September 2014 to January 2016. Studies were classified as positive or negative; indeterminate examinations, and those performed for chronic pulmonary emboli were excluded. A total of 1394 examinations ordered by 182 physicians were included, of which 199 (14.3%) were positive and 1195 (85.7%) were negative. A multivariable logistic regression analysis was performed to explore whether physician specialty, years in practice, physician sex, or total numbers of studies ordered per physician were associated with CTPA diagnostic yield. We used a generalized estimating equations (GEE) approach to account for patients who underwent repeated examinations over the study period. 3 Statistical tests of hypothesis were 2-sided with a significance of P ≤ .05. All analyses were performed using SAS statistical software (version 9.4, SAS Institute Inc). The McGill University Health Centre research ethics board approved this study.

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“…Mean doses of radiation from a simple CT head could range between 2 and 2.9 millisieverts (mSv). 14,15 Though the exact magnitude of risk is controversial at lower doses, the cumulative dose of multiple studies may potentially expose patients to the side effects of radiation.…”

Section: Ct Scan and Mrimentioning

confidence: 99%

Neuroimaging in the Emergency Department for Patients with Symptoms of Vitreoretinal Traction

et al. 2019

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Eye conditions result in 2.4 million emergency department (ED) visits annually. The purpose of this study is to investigate the management of patients with symptoms of vitreoretinal traction. Retrospective observational study was performed in three Northwell Health EDs between January 2014 and January 2017. Patients with monocular flashes, floaters, or changes in visual field for whom ophthalmology were consulted. Ninety-six patients were included (45 female), mean age 58.4 years. Complaints included floaters in 47 (49%), visual field changes in 39 (41%), and flashes in 28 (29%). Eighteen patients (19%) presented with more than one symptom. Of 24 patients with documented eye examinations by emergency physicians, 10 included confrontational visual fields (CVF). Before ophthalmology consultation, tests included blood work in 29 patients (30%), computerized axial tomography (CT) head in 33 (34%), orbit ultrasound in two (2%), magnetic resonance imaging (MRI) head in 1one (1%), and erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) in one (1%). Diagnoses by ophthalmologists were posterior vitreous detachment in 44 patients (46%), vitreous hemorrhage in 31 (32%), retinal detachment or tears in 12 (13%), central retinal artery occlusion in six (6%), and central or branch retinal vein occlusions in three (3%). Of 12 patients with retinal detachments or tears, 5 (42%) underwent surgery within 1 week. In patients presenting to the ED with symptoms of vitreoretinal traction, over 30% underwent imaging and blood work before ophthalmology consultation. Signs and symptoms of retinal pathology should be recognized promptly. Triaging, focused examination, and a detailed history may lead to fewer imaging studies and more cost savings.

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Radiation doses to emergency department patients undergoing computed tomography

Cited by 12 publications

References 34 publications

Incidence of combined cranial and cervical spine injuries in patients with blunt minor trauma: are combined CT examinations of the head and cervical spine justified?

Incidence of combined cranial and cervical spine injuries in patients with blunt minor trauma: are combined CT examinations of the head and cervical spine justified?

Association of Lower Diagnostic Yield With High Users of CT Pulmonary Angiogram

Neuroimaging in the Emergency Department for Patients with Symptoms of Vitreoretinal Traction

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