Early Computed Tomography Scan Research Articles

High-grade serous ovarian cancer (HGSOC) with fallopian tube involvement.

Literature data present new studies about precancerous lesions of pelvic serous carcinoma that originate from the tubal secretory cells. It has long been thought that ovarian cancer cannot be prevented by prophylactic screening or surgery. In recent years, gynecologists have adapted to new principles and so, during routine hysterectomies in perimenopausal women for benign uterine pathologies, salpingo-oophorectomy is performed as a prophylactic approach. The purpose of our article was to draw attention to the association between abnormal fallopian tube pathology and the presence of serous ovarian neoplasia in perimenopausal women at risk. We report the case of a 45-year-old woman who had unspecific symptoms of abdominal pain and loss of appetite and weight. A pelvic magnetic resonance imaging was performed, and an ovarian mass was detected. Our case shows that the fallopian tube can be the primary point of origin for a pelvic disease, therefore prevention is possible with early computed tomography scan and annual ultrasound. The patient presented with a T1c staging post-surgery and her chances of survival could have decreased if she had postponed medical examination longer. We found a significant increase in the absolute number of tubal secretory cells in patients with ovarian neoplasia, which supports the assumption that serous tubal intraepithelial carcinoma lesions are found especially in the serous ovarian type. Our article is a strong suggestion that serous ovarian cancer originates from the fallopian tube and can potentially serve as a sensitive biomarker for early serous carcinogenesis within the fallopian tube.

Early real-world experience monitoring circulating tumor DNA in resected early-stage non–small cell lung cancer

ObjectiveThe study objective was to evaluate the impact of monitoring circulating tumor DNA on the detection and management of recurrence in patients with resected early-stage non–small cell lung cancer. MethodsBetween October 2021 and March 2023, postoperative circulating tumor DNA was monitored in patients with non–small cell lung cancer (N = 108). Longitudinal blood samples (n = 378 samples) were collected for prospective circulating tumor DNA analysis at 3-month intervals after curative-intent resection. A tumor-informed assay was used for the detection and quantification of circulating tumor DNA. The primary outcome measure was a circulating tumor DNA–positive result. The secondary outcome measure was changes in practice after a circulating tumor DNA–positive result. ResultsThe mean age of the patients in this cohort was 68.1 years. Of the 108 patients, 12 (11.1%) were circulating tumor DNA positive at least at 1 timepoint postsurgery, of whom 8 (66.7%) had a clinically evident recurrence and the remaining 4 had limited clinical follow-up. Of the 10 patients with recurrent disease, 8 demonstrated circulating tumor DNA positivity and the remaining 2 patients had brain-only metastases. Postoperative clinical care was altered in 100% (12/12) of circulating tumor DNA–positive patients, with 58.3% (7/12) receiving an early computed tomography scan and 100% (12/12) receiving an early positron emission tomography computed tomography scan as part of their surveillance strategy. Among the patients who received an early positron emission tomography scan, 66.6% (8/12) were positive for malignant features. ConclusionsRoutine monitoring of tumor-informed circulating tumor DNA after curative intent therapy improved patient risk stratification and prognostication.

Lipoma of the Ileum: A Rare Cause of Intussusception in Adults

Bowel intussusception is a rare entity in adults. Symptoms are nonspecific and most of diagnoses are made by computed tomography scan. We report the case of an adult with bowel obstruction due to an ileoileal intussusception caused by a lipoma.A 44-year-old male patient with colicky epigastric pain since the day before, bilious vomiting, abdominal distension and epigastrium tenderness. Plain abdominal radiography revealed dilation of small bowel with gas-fluid levels and computed tomography scan suggested an ileoileal intussusception. We performed bowel resection comprising the lesion, removal of the regional lymph nodes and a primary anastomosis. The histopathology report revealed a lipoma. Patient was discharged on the fifth postoperative day.A lipoma is a rare cause of intussusception, with a challenging diagnosis, because of nonspecific symptoms. An early computed tomography scan is essential for the diagnosis and prompt surgical resection is recommended.

Hypertensive supratentorial intracerebral hemorrhage: clinical picture, diagnosis, treatment

Background. The paper analyzed the severity and prevalence of hypertensive supratentorial intracerebral hemorrhages (ICH). This pathology is an urgent problem in the global health context, as it leads to severe consequences, including disability and death of patients. Recent discoveries and clinical guidelines provide physicians and researchers with new opportunities to improve clinical practice and improve the effectiveness of treatment for these complications. An increase in the number of cases of hypertensive supratentorial intracerebral hemorrhages and their impact on public health makes this problem extremely relevant in the field of medicine. Materials and methods. Two hundred and thirty-two patients with supratentorial intracerebral hemorrhages caused by hypertension were examined and treated in 2019–2020 at the Kyiv City Clinical Emergency Hospital. The average age of patients was 60 years: for men, it was 56 years, for women 69 years. They were observed during treatment in the hospital for up to 21 days. On the 21st day, the degree of disability was assessed. All patients underwent a neurological examination with an assessment of consciousness according to the Glasgow Coma Scale, Intracerebral Hemorrhage Score, Barthel index, modified Rankin scale, National Institutes of Health Stroke Scale (NIHSS). We have used neuroimaging methods (computed tomography, magnetic resonance angiography, if necessary). Clinical and laboratory studies were conducted. Results. It was found that 127 (57 %) patients had putaminal supratentorial hemorrhage, 24 (10 %) — thalamic, 34 (15 %) — subcortical (in the white matter of the cerebral hemispheres), 47 (20 %) — mixed. Seventy-seven (33 %) patients were hospitalized in a coma (Glasgow Coma Scale ≤ 8 points), 36 (16 %) in a sopor, 81 (35 %) in a stunned state, and 31 (13 %) patients were conscious. Patients over 60 years of age had ICH of deep localization, while young patients had cortical ones. Ninety-four surgical interventions were performed in 84 patients with lobar and lateral hematomas, as well as with breakthrough into the ventricular system (liquid drainage surgery). General mortality was 39.5 %, surgical — 46.4 %. Contraindications for surgical interventions were as follows: an existing severe coma, unstable hemodynamics, the need for constant administration of vasopressors, as well as severe comorbid conditions. Conclusions. It was found that the clinical picture of acute supratentorial intracerebral hemorrhages against the background of hypertension is characterized by polymorphic neurological symptoms according to the localization of the hematoma, its volume, cerebral edema, and intracranial hypertension. The results of the treatment of patients with hypertensive ICH indicate the need for early hospitalization, early computed tomography scan, and a differentiated approach to surgical removal of the hematoma. The favorable outcome of supratentorial ICH is more typical for patients with initial mild and moderate neurological symptoms in case of a hemorrhage volume of less than 30 cm3. The presence of blood breakthrough into the ventricular system increases the risk of death by 35 times.

Compliance on the use of water-soluble contrast agent in adhesional small bowel obstruction

Objectives: Small bowel obstruction is associated with significant morbidity and mortality. This study aimed to map outcomes of patients admitted with adhesional small bowel obstruction (ASBO ) with a view evaluating the effectiveness of water-soluble contrast agents (WSCA). Materials and Methods: A retrospective review of all emergency admissions coded for operative and non-operative treatment of small bowel obstruction between January 2018 and June 2020. Electronic patient records were utilized to confirm cases of ASBO. Patient demographics, hospital administrative data, treatment and surgery-related data are collected. Results: A total of 110 patients were admitted with ASBO initiated with conservative management. Median time to computed tomography (CT) scan was 12 h (Range: 3–115 h). Oral contrast was administered in only 11%; of these, 58% (7/12) resolved spontaneously compared to 52% (51/98) in those without contrast. About 43% (47/110) of all patients necessitated surgical intervention. Median time from admission to surgery was 43.5 h (Range: 10– 288 h). There were one 30-day re-admissions in patients surgically managed compared to two in those conservatively managed. Conclusion: Early CT scan facilitates initiation of non-operative management in stable patients with ASBO. In this series, the scant use of WSCA despite international guidelines did not compromise patient outcomes or length of stay.

The influence of early adoption of nonenhanced computed tomography on management of patients with pyogenic liver abscess.

A pyogenic liver abscess (PLA) is an infectious disease with high in-hospital mortality. It has no specific symptoms and is difficult to be diagnosed early in the emergency department. Ultrasound is commonly used to detect PLA lesions of PLA, but its sensitivity can be affected by lesion size, location, and clinician experience. Therefore, early diagnosis and prompt treatment (especially abscess drainage) are crucial for better patient outcomes and should be prioritized by clinical physicians. We conducted a retrospective study to compare the effect of early and late (i.e., receiving CT scanning within 48 h and >48 h after admission) adoption of nonenhanced computed tomography (CT) scanning regarding the hospitalization days and interval between admission and drainage of patients with PLA. This study included 76 hospitalized patients with PLA in the Department of Digestive Disease of Xiamen Chang Gung Hospital in China who underwent CT examinations from 2014 to 2021. We conducted CT scans on 56 patients within 48 h of admission and on 20 patients more than 48 h after admission. The early CT group had a significantly shorter hospitalization length compared with the late CT group (15.0 days vs. 20.5 days; P = 0.035). Besides, the median time to initiate drainage after admission was also significantly shorter in the early CT group than in the late CT group (1.0 days vs. 4.5 days; P < 0.001). Early CT scanning within 48 h of admission may aid in early PLA diagnosis and benefit disease recovery, as revealed by our findings.

Early computed tomography after extracorporeal cardiopulmonary resuscitation on in-hospital survival: a retrospective cohort study.

The role of computed tomography (CT) scans after extracorporeal membrane oxygenation (ECMO) implantation in patients with refractory cardiac arrest has not been frequently investigated. Early CT scan findings may have many meaningful findings and contribute significantly to patients' outcome. In this study, we sought to determine whether early CT scans in such patients indirectly improved in-hospital survival. A computerized search of the electronic medical records systems of 2 ECMO centers was conducted. A total of 132 patients who had undergone extracorporeal cardiopulmonary resuscitation (ECPR) between September 2014 and January 2022 were included in the analysis. The patients were divided into 2 groups based on whether they underwent early CT scans (the treatment group) or did not undergo early CT scans (the control group). The findings of early CT scans and in-hospital survival were investigated. A total of 132 patients had undergone ECPR with 71 were male, 61were female and mean age: 48.0±14.3 years. Early CT scans did not improve patient's in-hospital survival [hazard ratio (HR): 0.705; P=0.357]. Overall, a smaller proportion of patients survived in the treatment group (22.5%) than the control group (42.6%; P=0.013). In total, 90 patients were matched in terms of age, initial shockable rhythm, Sequential Organ Failure Assessment (SOFA) score, cardiopulmonary resuscitation (CPR) duration, ECMO duration, percutaneous coronary intervention, and cardiac arrest location. In the matched cohort, fewer patients survived in the treatment group (28.9%) than the control group (37.8%; P=0.371), but the difference was not significant. According to a log-rank test, in-hospital survival did not differ significantly before and after matching (P=0.69, and P=0.63, respectively). Thirteen patients (18.3%) had complications during transportation, among which a drop in blood pressure was the most common. The in-hospital survival rate between treatment and control group was not different, however, early CT scan after ECPR could help clinicians to gain important information to guide clinical practice.

Early Postoperative CT Scan Provides Prognostic Data on Clinical Outcomes of Fresh Osteochondral Transplantation of the Knee

Background: There is a lack of information regarding the ability of imaging studies to predict clinical outcomes after fresh osteochondral allograft (FOCA) transplantation of the knee. Purpose: To determine the value of computed tomography (CT) scans to predict the clinical outcome of FOCA transplantation using the assessment computed tomography osteochondral allograft (ACTOCA) score. Study Design: Cohort study; Level of evidence, 3. Methods: We prospectively collected data from all consecutive patients who underwent FOCA transplantation for osteochondral knee lesions at one institution between August 2017 and August 2019. All patients were followed up for a minimum of 2 years. CT scans performed 6 months after surgery were evaluated by a musculoskeletal radiologist using the ACTOCA scoring system. The radiologist was blinded to the patient’s medical history. Clinical outcomes were assessed preoperatively and at 12 and 30 months postoperatively using the International Knee Documentation Committee (IKDC) score, the Kujala score, the Tegner activity scale, and the Western Ontario Meniscal Evaluation Tool (WOMET) score. Results: A total of 38 cases were included. The ACTOCA score at 6 months after surgery showed a statistically significant correlation with clinical results at 12 and 30 months. The correlation was better at 30 months, showing a high negative correlation with the IKDC score (−0.663) and a moderate negative correlation with the Kujala, WOMET, and Tegner scores (−0.593; −0.547, and −0.593, respectively) (P < .001). Conclusion: A statistically significant correlation between the mean ACTOCA score on CT scans at 6 months and the clinical results measured by the IKDC, Kujala, WOMET, and Tegner scores at 30 months confirmed the predictive value of the ACTOCA score for use in clinical practice.

Computed tomography assessment of postoperative gastric vascular supply and staple-line leak development after sleeve gastrectomy.

Residual arterial supply of the gastric tube after sleeve gastrectomy (SG) can be damaged by surgery, which can reduce gastric tube perfusion and could promote postoperative leakage. To compare the postoperative vascularization of the gastric tube using early computed tomography (CT) scanning after SG in patients with or without postoperative staple-line leak. University hospital. A retrospective analysis of a prospective database was performed in consecutive patients undergoing SG. Patients who presented with a staple-line leak were matched (1:3) with a control group of patients who underwent surgery without postoperative morbidity during the same period. Gastric tube vascularization was studied on a postoperative day 2 CT scan in both groups of patients. During the study period, 1826 patients underwent SG, including 42 patients (2.3%) who presented with a staple-line leak. Those 42 patients were successfully matched to 126 control patients. Global identification of residual gastric arterial supply in early postoperative CT scans was similar in patients with or without staple-line leak after SG. However, residual vascular supply of the gastroesophageal junction (i.e., terminal and anterior cardiotuberosity branches of the left gastric artery or left inferior phrenic artery) was more frequently interrupted by the staple line in the group of patients who developed a gastric leak. This study suggests a correlation between interruption of the main arteries supplying the gastroesophageal junction by the staple line on early postoperative CT scans and the development of gastric leak after SG. These results support the vascular theory as one of the causes of leak after SG.

Fully automatic volume segmentation using deep learning approaches to assess aneurysmal sac evolution after infrarenal endovascular aortic repair

ObjectiveEndovascular aortic repair (EVAR) surveillance relies on serial measurements of the maximal diameter despite significant inter- and intraobserver variability. Volumetric measurements are more sensitive; however, their general use has been hampered by the time required for their implementation. An innovative, fully automated software (PRAEVAorta; Nurea, Bordeaux, France), using artificial intelligence, had previously demonstrated fast and robust detection of the characteristics of infrarenal abdominal aortic aneurysms on preoperative imaging studies. In the present study, we assessed the robustness of these data on post-EVAR computed tomography (CT) scans. MethodsWe compared fully automatic and semiautomatic segmentation manually corrected by a senior surgeon (E.D.) using a dataset of 48 patients (48 early post-EVAR CT scans with 6466 slices and 101 follow-up CT scans with 13,708 slices). ResultsThe analyses confirmed the excellent correlation of the post-EVAR volumes and surfaces and the proximal neck and maximum aneurysm diameters measured using the fully automatic and manually corrected segmentation methods (Pearson’s coefficient correlation, >0.99; P < .0001). A comparison between the fully automatic and manually corrected segmentation methods revealed a mean Dice similarity coefficient of 0.950 ± 0.015, Jaccard index of 0.906 ± 0.028, sensitivity of 0.929 ± 0.028, specificity of 0.965 ± 0.016, volumetric similarity of 0.973 ± 0.018, and mean Hausdorff distance/slice of 8.7 ± 10.8 mm. The mean volumetric similarity reached 0.873 ± 0.100 for the lumen and 0.903 ± 0.091 for the thrombus. The segmentation time was nine times faster with the fully automatic method (2.5 minutes vs 22 minutes per patient with the manually corrected method; P < .0001). A preliminary analysis also demonstrated that a diameter increase of 2 mm can actually represent a >5% volume increase. ConclusionsPRAEVAorta enabled a fast, reproducible, and fully automated analysis of post-EVAR abdominal aortic aneurysm sac and neck characteristics, with a comparison between different time points. It could become a crucial adjunct for EVAR follow-up through the early detection of sac evolution, which might reduce the risk of secondary rupture.

Multiple different remote epidural hematomas after craniotomy: A case report

BACKGROUNDEpidural hematoma is one of the common postoperative complications after craniotomy. However, multiple remote epidural hematomas in different sites, including supratentorial and infratentorial regions, are exceedingly rare.CASE SUMMARYWe present a rare case in which three remote epidural hematomas occurred after craniotomy. A 21-year-old woman was admitted with a headache for 1 mo, vomiting, and rapid vision loss for 1 wk. Brian magnetic resonance imaging indicated a right thalamic tumor. The intraoperative diagnosis was a cystic tumor, posterior cerebral artery aneurysm, and vascular malformation. The operation was successful. Unfortunately, the patient developed three extradural hematomas within 48 h. Family members consented to the first two hematoma evacuations but refused the third.CONCLUSIONMore attention should be paid to this kind of rare complication. Adequate preoperative evaluation is important, especially for acute patients. Monitoring neural function and early computed tomography scanning of the brain after surgery should be highlighted.

The Unfolding Situation of Caecal Volvulus: A Retrospective Analysis of 36 Cases From a Single Center.

BackgroundCaecal volvulus (CV) is a rare cause of bowel obstruction. However, there has been a steady rise in the number of cases over the decades. The demographic profile of patients developing CV has changed to a much older population. We conducted a retrospective review to determine the incidence, demographic profile, management, and outcomes of CV patients in our institution during the last nine years.MethodologyA retrospective audit of all patients diagnosed with CV at Worcestershire Acute Hospitals NHS Trust between 01 January 2011 and 31 March 2020 was performed. Patients admitted with any other type of volvuli such as sigmoid volvulus, small bowel volvulus, and gastric volvulus were excluded.A systematic search of the electronic medical records for all patients admitted under the International Classification of Diseases, Tenth Revision code K562: volvulus was performed for the study duration. It yielded a total of 1,019 patients. After excluding all patients who did not have either a CV or caecal bascule, we included 36 patients in the final analysis.ResultsMost of our patients were females (78%) with a median age was 76 years. The majority (86%) had at least one medical comorbidity, and 36% had a previous abdominal operation. Abdominal pain was the main complaint in 94% of patients. All patients had undergone a computed tomography (CT) scan to confirm their diagnosis. Most of our patients (84%) underwent surgery. Open right hemicolectomy was the most commonly performed operation (87%). Out of the six patients who did not undergo surgery, three responded to bowel rest and nasogastric tube decompression; one patient underwent successful colonoscopic decompression. In contrast, two patients, unfortunately, passed away. The median length of hospital stay was nine days, with a 30-day mortality of 3%.ConclusionsCV remains a rare cause of bowel obstruction. Most of our patients were old, frail, and had medical comorbidities. More than one-third of patients had undergone previous abdominal surgery. Early CT scan followed by right hemicolectomy was associated with low mortality.

Timing of brain computed tomography for predicting neurological prognosis in comatose cardiac arrest survivors: a retrospective observational study.

To assess the association between relevant brain computed tomography (CT) parameters at different time and neurological prognosis in adult comatose survivors after cardiac arrest (CA). A total of 94 CA patients who underwent early and late CT scans (within 24 h and 24 h to 7 d respectively after CA) between January 2018 and April 2020 were enrolled in this retrospective study. According to the Cerebral Performance Category (CPC) score at hospital discharge, the patients were divided into either a good outcome (CPC 1-2) group or a poor-outcome group (CPC 3-5). The grey-to-white matter ratio (GWR) and the proportion of cerebrospinal fluid volume (pCSFV) were measured. In predicting poor outcomes, the prognostic performance of relevant CT parameters was evaluated, and the comparison analysis (expressed as the ratio of parameters in late CT to those in the early CT) of different CT time was conducted. Totally 26 patients were in the good-outcome group, while 68 patients were in the poor-outcome group. The putamen density, GWR, and pCSFV in late CT were significantly lower in the poor-outcome group (P<0.05). The ratios of GWR and pCSFV in the poor-outcome group were significantly decreased according to comparison analysis of different CT time (P<0.05), while there was no significant difference in the ratio of putamen density. GWR-basal ganglia <1.18 in late CT showed the best predictive value. The ratio of pCSFV <0.98 predicted unfavorable neurological outcomes with a sensitivity of 65.9% and a specificity of 93.8% (P=0.001). Brain CT performed >24 h after CA may be a good choice as a neuroimaging approach to evaluating prognosis. To predict neurological prognosis, comparison analysis of different CT time can be used as another promising tool in comatose CA survivors.

A rare case of fetal gas gangrene following premature rupture of membranes in the second trimester diagnosed with the aid of computed tomography

Introduction: To report a rare case of foetal gas gangrene following premature rupture of membranes in the second trimester diagnosed with the aid of computed tomography. Case Report: A 33-year-old lady, with G4A2L1, booked and vaccinated, developed premature rupture of membranes at 25 weeks of gestation. She developed severe abdominal pain with high-grade fever on the fourth night after expectant management with intravenous antibiotics and close monitoring. As there was a new-onset shock, she was referred to the higher centre from the obstetric care unit. The ultrasound of the abdomen and pelvis in the emergency room ruled out other causes of shock but confirmed intrauterine death. After planning for vaginal delivery, she had further deterioration requiring intubation and vasopressors. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis was performed which showed foetal gas gangrene and bilateral acute cortical necrosis. Emergency hysterotomy, performed under high-risk consent delivered macerated foetus. She had atonic uterus and required obstetric hysterectomy under general anaesthesia (GA). Her post-partum course was complicated by disseminated intravascular coagulopathy (DIC), acute respiratory distress syndrome (ARDS) and multiorgan dysfunction syndrome requiring multiple transfusions, prone ventilation and multiorgan support. However, she could not be salvaged and died on the 2nd day of surgery. Conclusion: We describe a rare fatal case of foetal gas gangrene in the second trimester following premature rupture of membranes which was diagnosed by a computed tomography (CT) scan of the abdomen and pelvis. The CT scan reliably identifies emphysematous changes in the amniotic cavity and foetal parts which helps in decision-making from the induction of labour to early surgical approach to prevent peritonitis and multiorgan failure. We recommend early CT scan in pregnancies complicated by intrauterine infections with shock which can change the line of management.

P-P52 Overuse of CT scans in the diagnosis of Acute Pancreatitis

Abstract Background Acute pancreatitis is an acute inflammatory process affecting the pancreas with variable involvement of local tissues and remote organs and may sometimes progress into necrosis of the pancreas. Diagnosis is usually made based on the clinical presentation of abdominal pain alongside a positive biochemical result of either serum amylase or lipase levels. Current guidelines by International Association of Pancreatology (IAP) state that early use of computed tomography (CT) is only indicated in patients who have no definite diagnosis, and should be delayed to at least 96 hours after the onset of the symptoms to evaluate complications. We aimed to assess the over-utilization of CT scans in the diagnosis of acute pancreatitis. Methods We performed a prospective cohort study of patients with confirmed acute pancreatitis who presented to a single NHS trust between March and April 2021. We included patients with at least two out of the three findings: (1) an acute abdominal pain, (2) elevated serum amylase levels of more than three times the normal range and (3) acute pancreatitis as evidenced on abdominal imaging. We defined inappropriate CT scans as those performed within 96 hours in the presence of both clinical and biochemical diagnostic criteria. Results A total of 53 patients met the inclusion criteria and were admitted with acute pancreatitis during this 2-month period at our trust. 54.7% (29/53) of this cohort had at least one CT scan performed during the index admission. 28.3% (15/53) of the admitted patients had an early CT scan performed in the presence of positive biochemical and clinical diagnostic criteria. This represents 51.7% of the total number of CT scans performed in the study group. Conclusions We found evidence of excessive use of CT scans in the early phase of acute pancreatitis for diagnostic purposes. Limiting the overuse of CT scans in the diagnosis of the same will not just reduce the financial burden of the hospital and trust, but also limit the avoidable exposure of patients to radiation.

EP.FRI.376 Early Routine CT Scans for All Surgical Admissions for Abdominal Pain May Improve Patient Outcomes

Abstract Aim Acute abdominal pain remains a diagnostic challenge in the Emergency Department (ED) as pathologies can involve various surgical craft groups. Computed tomography (CT) enables accurate diagnosis of abdominal pathologies. However, with pressures on ED such as the “4 hour rule” established by the Australian NSW Health Emergency Performance Plan, there may be resistance or omission of early CT in ED. We hypothesise that early, routine CT in adult patients presenting with acute abdominal pain requiring hospital admission improves patient outcomes by increasing diagnostic and referral accuracy. This study compares the proportion of correct ED diagnosis of abdominal pain presentations with and without formal imaging reports. Methods Data from 118 patients presenting with abdominal pain are collected prospectively in a regional hospital and analysed. Patient demographics, imaging results, initial ED diagnosis and final discharge diagnosis are further examined. Results Out of the 118 patients who had abdominal pain, 32 patients obtained complete imaging with a radiology report whilst 86 patients either did not have any imaging performed or was referred to a general surgical unit prior to obtaining a formal report. Among the patients who had imaging reported, 78% (n = 25/32) had the correct diagnosis, whilst those without a radiology report had a 52% (n = 45/86) diagnostic accuracy. This demonstrates an improved accuracy of diagnosis or reduced error rate of 26% when a scan report is available (p = 0.01). Conclusion Early, routine CT with formal reporting significantly reduces diagnostic error rates and increases accurate referral. This allows accurate diagnosis and improves patient outcomes.

Early head-to-pelvis computed tomography in out-of-hospital circulatory arrest without obvious etiology.

Patients resuscitated from an out-of-hospital circulatory arrest (OHCA) commonly present without an obvious etiology. We assessed the diagnostic capability and safety of early head-to-pelvis computed tomography (CT) imaging in such patients. From November 2015 to February 2018, we enrolled 104 patients resuscitated from OHCA without obvious cause (idiopathic OHCA) to an early sudden-death CT (SDCT)scan protocol within 6 h of hospital arrival. The SDCT protocol included a noncontrast CT head, an electrocardiogram-gated cardiac and thoracic CT angiogram, and a nongated venous-phase abdominopelvic CT angiogram. Patients needingurgent cardiac catheterizationor hemodynamically unable to tolerate SDCT were excluded. Cardiac CT analyses were blinded, but other SDCT findings were clinically available. Primary endpoints were the number of OHCA causes identified by SDCT compared tothe adjudicated cause and critical diagnoses identified by SDCT, including resuscitation complications. Safety endpoints were acute kidney injury (AKI) and inappropriate treatments based on SDCT findings. Acute coronary syndrome was the presumed etiology if any major coronary artery had a>50% stenosis without another OHCA cause. SDCT scans occurred within 1.9±1.0h of hospital arrival and identified 39% (41/104) of all OHCA causes and 95% (39/41) of causes potentiallyidentifiable by SDCT. Critical findings were identified by SDCT in 98% (43/44) of patients that included potentially life-threatening resuscitation complications of liver or spleen laceration (n=6); pneumothorax or thoracic organ laceration (n=8); and mediastinal, pericardial, or vascular hemorrhage (n=3). SDCT exclusively identified 13 (13%) OHCA causes that would otherwise not be identified without SDCT imaging. No inappropriate treatmentsresulted from SDCT findings. AKI was common (28%) but only one (1%) patient required new dialysis. This observational cohort study suggests that early SDCT scanning is safe, can expedite the diagnosis of potential causes, and can meaningfully change clinical management after idiopathic OHCA.

Doughnut vertebroplasty for circumferential aggressive vertebral hemangiomas

BackgroundTo assess the feasibility, safety and efficacy of a percutaneous doughnut vertebroplasty of circumferential aggressive vertebral hemangiomas (VHs).MethodsWe retrospectively reviewed our prospectively collected database of patients with VHs treated with...

The Utility of Early Postoperative Neuroimaging in Elective/Semielective Craniotomy Patients: A Single-Arm Prospective Trial

The necessity and timing of early postoperative imaging (POI) are debated in many studies. Despite the consensus that early POI does not change patient management, these examinations are routinely performed. This is the first prospective study related to POI. Our aims were to assess the necessity of early POI in asymptomatic patients and to verify accuracy of the presented algorithm. This was an algorithm-based prospective single-center study. The algorithm addressed preoperative, perioperative, and postoperative considerations, including estimated pathology type, device placement, and postoperative neurologic change. Early computed tomography scans were obtained in all patients, but if postoperative algorithm indications did not recommend a scan, the treating team was blinded to them, and patient management was conducted based on clinical examinations alone. A neuroradiologist and study-independent neurosurgeon reviewed all the scans. Of 103 enrolled patients, 88 remained asymptomatic, and 15 experienced symptoms postoperatively. Pathology was present on POI in 1% of the asymptomatic patients and 53% of the symptomatic patients (P < 0.001). In the asymptomatic group, no treatment modifications were made postoperatively. Blinding of the surgical team was not removed, and 20% of the symptomatic patients returned to the operating room because of imaging and neurologic findings. The goal of <5% algorithm failure was reached with statistical significance. In asymptomatic postoperative patients in whom early imaging is not performed for oncologic indications, device placement verification, or similar reasons, POI is unnecessary and does not change the management of these patients.

Time to computed tomography: does this affect trauma patient outcomes? A retrospective analysis at an Australian major trauma centre.

Computed tomography (CT) is an essential diagnostic tool for severe multi-trauma patients. International guidelines recommend an optimal time of 1 h from arrival. The aim of this study was to determine the time interval from arrival at the emergency department to CT for all trauma patients and the effects on in-hospital mortality and hospital length of stay. Retrospective study of all patients who triggered a trauma call and underwent CT scanning at the Gold Coast University Hospital from January 2016 to December 2017. Exclusion criteria were scans performed at peripheral hospitals or performed more than 5 h after arrival to emergency department. One thousand six hundred and nineteen eligible trauma patients were admitted over the study period and underwent CT scanning. Median time to CT was found to be 43 min. CTs done within 1 h compared to those done after 1 h from emergency department arrival were found to have a higher mean injury severity score (11 ± 10 versus 9 ± 9, P = 0.003), a longer mean hospital length of stay (9 ± 21 versus 7 ± 13 days, P = 0.012) and no difference in mortality rates (2.2% versus 2.1%, P = 1.000). Age, injury severity score and intubation status were identified as independent predictors for longer hospital length of stay and higher mortality while time to CT did not. Injury severity score was shown to be an independent predictor of time to CT. Our time to CT scanning is well within the timeframe recommended by international guidelines. Early CT scanning may also improve outcomes in severely injured trauma patients.