The American journal of emergency medicine
-
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 -
Multicenter Study Observational Study
Features of hospital and emergency medical service in out-of-hospital cardiac arrest patients with shockable rhythm.
Predicting the outcome of out-of-hospital cardiac arrest (OHCA) patients is crucial. We examined hospital characteristics and parameters of emergency medical service (including scene time interval and direct ambulance delivery to intensive heart hospitals) as survival or outcome predictors. ⋯ Direct ambulance delivery to intensive heart hospitals that had 24/7 PCI availability was associated with a higher probability of surviving until discharge in OHCA patients with shockable rhythms. Similarly, a witnessed collapse was correlated with being discharged alive from hospital and recovering with good cerebral performance. In addition, longer response time and scene time interval indicated poorer survival and neurological outcome.
-
Multicenter Study
The relative contribution of provider and ED-level factors to variation among the top 15 reasons for ED admission.
We examine adult emergency department (ED) admission rates for the top 15 most frequently admitted conditions, and assess the relative contribution in admission rate variation attributable to the provider and hospital. ⋯ For different conditions, there were different contributions to variation at the hospital- and provider-level. These findings deserve consideration when designing interventions to optimize admission decisions and in value-based payment programs.
-
To determine the impact of a non-restrictive clinical decision rule on CT utilization for Emergency Department patients suspected of having an acute aortic syndrome (AAS). ⋯ A non-restrictive, collaboratively designed, clinical decision rule for Emergency Department patients with suspected AAS performed poorly in risk-stratifying patients for AAS. However, its implementation was associated with a significant and safe decrease in CT utilization.
-
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.