The American journal of emergency medicine
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Comparative Study
Which is better and useful modality of X-ray for diagnosis of pneumothorax at emergency setting: Conventional or invert-grayscale?
Why is this interesting?
Digital radiology systems (PACS) allow point-of-care enhancement and adjustment of x-ray images. 'Inverted grayscale' viewing has been advocated as a way to improve the ability to detect small pneumothoraces on posterior-anterior chest x-rays (CXR).
This case-control cross-over study challenges this practice.
What did they do?
The researchers used CXRs of 106 adult patients with a known spontaneous pneumothorax and 162 matched-controls without pneumothorax, but who had presented with pneumothorax-consistent symptoms.
Using a senior radiologist as the gold standard diagnostician, two groups of five emergency physicians were then allocated to identify the presence of a pneumothorax in all 268 CXRs – one group using inverted grayscale and the other the conventional digital view.
To ensure the groups were comparable, the researchers also had each review a random selection of both inverted and conventional images, and compared how the group diagnostic sensitivities correlated.
Bottom-line:
Surprisingly, the sensitivity of pneumothorax detection was higher for conventional imaging than when using inverted grayscale (91.7% vs 84.5%). Specificity was comparable.
Be smart…
Although the researchers showed the inferiority of isolated inverted-grayscale imaging compared to conventional, it is a technique almost always used alongside first viewing a CXR with conventional contrast. Thus even if inferior, it is unlikely to undermine the diagnostic sensitivity of standard CXR reporting.
summary -
Chest pain accounts for a significant percentage of emergency department (ED) presentations. The HEART score and pathway have demonstrated an ability to appropriately risk stratify and discharge from the ED a significant proportion of patients. ⋯ Appropriate use of the HEART pathway reliably risk stratifies patients. Physicians must consider several key components when utilizing the HEART pathway, and future directions may incorporate other patient factors.
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Multicenter Study
Lung ultrasonography to diagnose pneumothorax of the newborn.
To explore the reliability and accuracy of lung ultrasound for diagnosing neonatal pneumothorax. ⋯ Lung ultrasound is accurate and reliable in diagnosing and ruling out neonatal pneumothorax and, in our study, was found to be as accurate as chest X-ray.
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The emergency department (ED) is frequently the doorway to the intensive care unit (ICU) for a significant number of critically ill patients presenting to the hospital. Hemodynamic monitoring (HDM) which is a key component in the effective management of the critically ill patient presenting to the ED, is primarily concerned with assessing the performance of the cardiovascular system and determining the correct therapeutic intervention to optimise end-organ oxygen delivery. ⋯ This article comprises an in depth discussion of an approach to hemodynamic monitoring techniques and principles as well as methods of predicting fluid responsiveness as it applies to the ED clinician. We review the role, applicability and validity of various methods and techniques that include; clinical assessment, passive leg raising, blood pressure, finger based monitoring devices, the mini-fluid challenge, the end-expiratory occlusion test, central venous pressure monitoring, the pulmonary artery catheter, ultrasonography, bioreactance and other modern invasive hemodynamic monitoring devices.