scholarly journals Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

2017 ◽  
Vol 11 (3-4) ◽  
pp. 88 ◽  
Author(s):  
Peter Alexander Massaro ◽  
Avinash Kanji ◽  
Paul Atkinson ◽  
Ryan Pawsey ◽  
Tom Whelan
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Urinary Calculi ◽  
Signs And Symptoms ◽  
Helical Ct ◽  
Opioid Dose ◽  
Patient Demographics ◽  
Included Patient ◽  
Emergency Department Patients ◽  
Urological Intervention

Introduction: Our objective was to determine whether unilateral calculus-induced ureteric obstruction on computed tomography (CT) was independently associated with the need for urological intervention and 30-day return to the emergency department (ED).Methods: We performed a retrospective cohort study of patients with symptomatic urinary calculi diagnosed by unenhanced helical CT. Stepwise regression analysis was used to determine the predictors of urological intervention and 30-day return to the ED. Potential predictors assessed included: patient demographics, calculus size, calculus location, degree of obstruction, analgesic doses, signs and symptoms of infection, serum creatinine, cumulative intravenous fluid administered, and the prescription of medical expulsive therapy.Results: Of 195 patients, 81 (41.5%) underwent urological intervention. The size of the calculus, its location, and the cumulative opioid dose were all independent predictors for urological intervention. Every 1 mm increase in calculus size increased the likelihood of intervention 2.2 times (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.67‒2.85). Proximal stones were 4.7 times more likely to require intervention than distal calculi (OR 0.21; 95% CI 0.09‒0.49). Every 10 mg increase in morphine was associated with a 30% increase in the odds of intervention (OR 1.30; 95% CI 1.07‒1.58). Degree of obstruction was not associated with the need for urological intervention. Finally, none of the variables were predictors for 30-day return to the ED.Conclusions: Although stone size, proximal location, and severe pain, as indicated by higher opioid doses, were associated with the need for intervention, the degree of obstruction did not influence the management of patients with CT-defined urinary calculi.

scholarly journals Characteristics and outcomes of older emergency department patients assigned a low acuity triage score

CJEM ◽  
2018 ◽  
Vol 20 (5) ◽  
pp. 762-769 ◽  
Author(s):  
Ariel Hendin ◽  
Debra Eagles ◽  
Victoria Myers ◽  
Ian G. Stiell
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Admission Rate ◽  
High Risk Population ◽  
Chi Square ◽  
Patients Âgés ◽  
Patient Demographics ◽  
Included Patient ◽  
Emergency Department Patients ◽  
Stratified Analysis

AbstractObjectiveAlthough older patients are a high-risk population in the emergency department (ED), little is known about those identified as “less acute” at triage. We aimed to describe the outcomes of patients ages 65 years and older who receive low acuity triage scores.MethodsThis health records review assessed ED patients who were ages 65 years and above or ages 40 to 55 years (controls) who received a Canadian Triage Acuity Scale score of 4 or 5. Data collected included patient demographics, ED management, disposition, and a return visit or hospital admission at 14 days. Data were analysed descriptively and chi-square testing performed. A pre-planned stratified analysis of patients ages 65 to 74, 75 to 84, and 85 and older was conducted.ResultsThree hundred fifty older patients with a mean age of 76.5 years and 150 control patients were included. Most patients presented with musculoskeletal or skin complaints and were triaged to the ambulatory care area. Older patients were significantly more likely than controls to be admitted on the index visit (5.0% v. 0.3%, p=0.016) and on re-presentation (4.0% v. 0.7%, p=0.045). In a subgroup analysis, patients ages 85 years and above were most likely to be admitted (8.9%, p=0.003).ConclusionsOlder patients who present to the ED with issues labelled as “less acute” at triage are 16 times more likely to be admitted than younger controls. Patients ages 85 years and up are the primary drivers of this higher admission rate. Our study indicates that even “low acuity” elders presenting to the ED are at risk for re-presentation and admission within 14 days.

CT Abdominal Tomography Indications: Are We All Sticking to the Plan?

2020 ◽  
pp. 084653712095107
Author(s):  
Michael Pyper ◽  
Abdulwahab Sidiqi ◽  
Patrik Rogalla ◽  
Sam Sabbah ◽  
Ania Kielar
Keyword(s):  
Emergency Department ◽  
Radiation Dose ◽  
Patient Outcomes ◽  
Abdominal Radiography ◽  
Low Radiation Dose ◽  
Patient Demographics ◽  
Included Patient ◽  
Significant Difference ◽  
Quality Assurance Project ◽  
Emergency Department Patients

Objective: Ultra-low radiation dose computed tomography (CT) abdominal tomography was introduced in our institution in 2016 to replace standard abdominal radiography in the investigation of emergency department patients. This project aims to ascertain whether investigation of emergency department patients using ultra-low radiation dose CT abdominal tomography complies with original indication guidelines and/or if there has been any “indication creep” 3 years after inception. Methods: Retrospective, quality assurance project with research ethics waiver. A review of 200 consecutive patients investigated with CT abdominal tomography between February and May 2017 was performed. This was compared with 200 consecutive patients investigated between February and May 2019. Data analyzed included patient demographics, indication for scan, as well as scan and patient outcomes. Results: In the 2017 group, 29/200 scans were noncompliant with approved indication guidelines. In the 2019 group, 30/200 scans were also noncompliant. There was no statistically significant difference between groups ( P < .05) regarding the use of approved indications. Forty of 200 scans performed in 2017 revealed additional findings which are not specifically addressed on the reporting template. Forty-one of 200 scans in 2019 revealed these findings. Conclusions: There has been no “indication creep” for CT abdominal tomography over time.

Incremental Value of Computed Tomography in Triaging Emergency Department Patients with Acute Chest Pain

2012 ◽  
Vol 63 (4) ◽  
pp. 275-279
Author(s):  
Kristy Lee ◽  
Manstein Kan ◽  
Rashin F. Rastegar ◽  
Elizabeth Roy ◽  
Ferco H. Berger ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Chest Pain ◽  
Acute Chest Pain ◽  
Incremental Value ◽  
Emergency Department Patients
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