Accuracy of emergency medicine ultrasound in the evaluation of abdominal aortic aneurysm

This study assesses the accuracy of Emergency Medicine (EM) residents in detecting the size and presence of abdominal aortic aneurysms (AAAs) using EM ultrasound (EUS) compared to radiology measurement (RAD) by computed tomography (CT) scan, magnetic resonance imaging (MRI), angiography, or operative findings. There were 238 aortic EUS performed from 1999–2000; 36 were positive for AAA. The EUS finding of “AAA” had a sensitivity of 0.94 (0.86–1.0 95% confidence interval [CI]) and specificity of 1 (0.98–1.0 95% CI). Mean aortic diameter among patients with AAA identified by EUS was 5.43 ± 1.95 cm and by RAD was 5.35 ± 1.83 cm. The mean absolute difference between EUS and RAD diameters was 4.4 mm (95% CI 3.7–5.5 mm). Regression of EUS on RAD diameters is strongly correlated, with R² = 0.92. EM residents with appropriate training can accurately determine the presence of AAA as well as the maximal aortic diameter.     

Earthquake epidemiology: the 1994 Los Angeles Earthquake emergency department experience at a community hospital

INTRODUCTION: To assess the volume of patients and the composition of their injuries and illnesses that presented to an emergency department (ED) close to the epicenter of an earthquake that occurred in a seismically prepared area. METHODS: A retrospective analysis of data abstracted from charts and ED logs for patient census and types of injuries and illnesses of the patients who presented in the ED of a community hospital before and after the earthquake (6.8 Richter scale) that occurred in 1994 in Los Angeles. Illnesses were classified as trauma- and non-trauma related. Data were compared with epidemiological profiles of earthquakes in seismically prepared and unprepared areas. RESULTS: A statistically significant increase in ED patient census over baseline lasted 11 days. There was a large increase in the number of traumatic injuries such as lacerations and orthopedic injuries during the first 48 hours. Beginning on the third day after the event, primary care conditions predominated. When the effects of the LA quake were compared with those of similar Richter magnitude and disruptive capability, the ED epidemiology profile was similar to those in seismically unprepared areas, except for the total number of casualties. CONCLUSION: The majority of patients with traumatic injuries presented within the first 48 hours. The increase relative to baseline lasted 11 days. Efforts to develop disaster response systems from resources outside the disaster-stricken area should focus on providing mostly primary care assistance. Communities in seismically prepared areas could require external medical assistance for their EDs for up to two weeks following the event.     

Utilization of computed tomography imaging in the pediatric emergency department

Background

In recent years, there has been a movement toward more judicious use of computed tomography (CT) imaging in an attempt to limit exposure of pediatric patients to ionizing radiation. The Image Gently Alliance and like-minded movements began advocating for safe and high-quality pediatric imaging worldwide in the late 2000s.

Objective

In the context of these efforts, we evaluate CT utilization rates in the pediatric emergency department at a major academic medical center.

Materials and methods

We tracked utilization in several categories of CT, magnetic resonance imaging (MRI) and ultrasonography (US) between July 2008 and June 2017 and compared them with utilization rates from 2000 to 2006.

Results

A total of 4,955 pediatric patients underwent a total of 5,973 CT scans, 2,775 US studies and 293 MRI scans while in the pediatric emergency department during the 2008–2017 study period. We observed decreases in CT scans across all categories, ranging from a 19% decrease in abdominal CT to a 66% decrease in chest CT. Relatively greater decreases in CT scans were observed in patients younger than 3 years of age as compared to older children and adolescents. Abdominal and pelvic US increased. Brain MRI also increased over the final two years of the study.

Conclusion

CT utilization decreased throughout the 2008–2017 study period.