The effect of point-of- care ultrasonography on emergency department length of stay and CT utilization in children with suspected appendicitis

Tsung, James W.; Tay, Ee Tein; Elikashvili, Inna

doi:10.1186/2036-7902-6-s1-a32

Cited by 1 publication

(1 citation statement)

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“…Factors contributing to the low rate of CT scans are clear clinical decision rules and use of point-of-care ultrasound, which impact decision-making and diagnostic work-up of patients. [17,18] This is another important indicator of CT scan use, confirmed by many studies that show lower rates of use equating to higher positive detection rates. [8][9][10]19] As our CT use rate is lower than that of other EDs, our ED might be performing too few CT scans.…”

Section: Researchmentioning

confidence: 84%

High positive computed tomography yields in the emergency department might not be a positive finding

Swartzberg

Goldstein

2018

S Afr Med J

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Background. There is growing pressure to reduce unnecessary computed tomography (CT) imaging requests that the radiology department receives from the emergency department (ED); however, information on acceptable usage rates and diagnostic yields remains scanty. Objectives. To describe the indications, clinical categories and positive yield rates of patients receiving CT scans in the ED. Methods. A retrospective record review was done of all patients who received CT scans at an urban, adult academic ED during a 4-month period. Primary outcomes were to establish CT scan usage and positive yield rates. Other outcomes included analysis of indications, demographics and anatomical areas scanned. Results. Scans (n=1 010) were analysed. The median age of patients was 36 (range 4 -93) years. Male patients received 64.3% of all scans, as well as 75.7% of the scans performed for trauma. The majority of the scans were for trauma patients. However, non-trauma patients had a higher positive yield; the non-trauma positive yield rate was 61.8% compared with the trauma positive yield rate of 47.1% (p<0.001). The majority of scans performed were of the head (58%) and neck (20%), with lowest positive yield rates of 48.9% and 17%, respectively. The overall CT scan usage rate was 4.6% and overall positive rate 53.8%. Conclusion. A negative CT scan does not necessarily mean that the test was not indicated. Higher positive yield rates may reflect insufficient use of CT scanning by the ED. Local guidelines should be established to ensure judicious and effective clinical use of CT scans.

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