Original scientific paper
Emergency department chest and abdominal computed tomography: impact on patients’ management
Matteo Brambati
; Unità Sanitaria Complessa di Pronto Soccorso Azienda Ospedaliera della provincia di Lodi Via Kennedy 18, 20097 San Donato Milanese (MI), Italy
Stefano Paglia
; Unità Sanitaria Complessa di Pronto Soccorso, Azienda Ospedaliera della provincia di Lodi, Lodi, Italy
Fiorangela Marletta
; Unità sanitaria semplice di Pronto Soccorso/Dipartimento Emergenza e Accettazione, IRCCS Policlinico San Donato, San Donato Milanese, Italy
Roberto La Rocc
; Unità sanitaria semplice di Pronto Soccorso/Dipartimento Emergenza e Accettazione, IRCCS Policlinico San Donato, San Donato Milanese, Italy
Abstract
Objective. The introduction of computed tomography (CT) has had a very significant impact on patient evaluation and management decisions in the Emergency Department (ED). One of the few published studies demonstrated a positive CT yield in 67% of patients admitted to hospital. The same study demonstrated that in 25% of cases, the CT examination was able to identify a pathological process unidentified by the ED team. Only one study has focused on the evaluation of the variation in patient management that each CT examination is able to achieve. The purpose of our study is to document the impact that CT has on patient diagnosis and management in the ED, employing a large patient series.
Materials and methods. The diagnostic and therapeutic impact of CT was evaluated in a consecutive series of 300 patients who were referred to the radiology department for a chest or abdominal CT examination as requested by the emergency physician.
Results. The net impact of performing a CT was a change in planned treatment in 202 cases out of 300 (67%) and proceding with the planned treatment in the remaining 98 cases (33%). The only intention to demand a CT examination was significantly bound (p=0.015, confidence interval 0.16 and 0.38) to a change in the planned treatment before CT (as it is established with Mc Nemar test).
Discussion. Our study showed that more than 67% of CT reports were able to change the course of treatment planned before CT execution and that in 56% of these cases, the execution of a CT examination was able to generate a major variation in treatment plan
Keywords
emergency department; computed tomography; chest; abdomen; clinical impact
Hrčak ID:
170159
URI
Publication date:
1.5.2016.
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