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Thomas Geeraerts - One of the best experts on this subject based on the ideXlab platform.
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diagnostic performance of abdominal point of care ultrasound performed by an Emergency Physician in acute right iliac fossa pain
Critical Ultrasound Journal, 2018Co-Authors: Jeaneudes Bourcier, Emeric Gallard, Jeanphilippe Redonnet, Magali Majourau, Dominique Deshaie, Jeanmarie Bourgeois, Didier Garnier, Thomas GeeraertsAbstract:Right iliac fossa abdominal pain is a common reason for Emergency ward admissions, its etiology is difficult to diagnose. It can be facilitated by an imaging examination, such as a Computerized Tomography scan which exposes the patient to ionizing radiation and implies delays. A bedside ultrasound performed by Emergency Physicians could avoid these issues. The aim of our study was to assess the performance of ultrasound carried out at the patient’s bedside by an Emergency Physician compared with a clinical-laboratory examination for the diagnosis of a surgical pathology in right iliac fossa pain. This is a single-center prospective cohort study conducted in an Emergency Department receiving 19,000 patients per year. All patients presenting pain in the right iliac fossa were included by four (out of ten) Emergency Physicians certified in an ultrasound examination. A full grid pattern scan ultrasound of the abdominal cavity with analysis of the right iliac fossa was performed. The primary outcome was to compare the diagnosis performance of bedside ultrasound and clinical-laboratory examination to detect a surgical pathology. Two Emergency Physicians who did not participate in the study made the final diagnosis (i.e., surgical or non-surgical pathology) by reviewing the entire medical chart of each patient. From January 2011 to July 2013, 158 patients with a median age of 17 [13–32] years were analyzed. The diagnosed cases were: appendicitis (53), non-specific abdominal pain (48), lymphadenitis (22), ileitis (11), complicated ovarian cysts (7), neoplasias (5), inflammatory or infectious colitis (5), inguinal herniations (3), bowel obstructions (2), and salpingitis (2). The accuracy of ultrasound diagnoses was 0.89 (95% CI 0.84–0.94) versus 0.70 (95% CI 0.57–0.82) for diagnoses based on clinical-laboratory examination only (p < 0.001). Bedsides, ultrasound allows an accurate diagnosis of a surgical pathology in 89% of cases, which is more efficient than the clinical-laboratory examination.
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Diagnostic performance of abdominal point of care ultrasound performed by an Emergency Physician in acute right iliac fossa pain
SpringerOpen, 2018Co-Authors: Jeaneudes Bourcier, Emeric Gallard, Jeanphilippe Redonnet, Magali Majourau, Dominique Deshaie, Jeanmarie Bourgeois, Didier Garnier, Thomas GeeraertsAbstract:Abstract Background Right iliac fossa abdominal pain is a common reason for Emergency ward admissions, its etiology is difficult to diagnose. It can be facilitated by an imaging examination, such as a Computerized Tomography scan which exposes the patient to ionizing radiation and implies delays. A bedside ultrasound performed by Emergency Physicians could avoid these issues. The aim of our study was to assess the performance of ultrasound carried out at the patient’s bedside by an Emergency Physician compared with a clinical-laboratory examination for the diagnosis of a surgical pathology in right iliac fossa pain. Methods This is a single-center prospective cohort study conducted in an Emergency Department receiving 19,000 patients per year. All patients presenting pain in the right iliac fossa were included by four (out of ten) Emergency Physicians certified in an ultrasound examination. A full grid pattern scan ultrasound of the abdominal cavity with analysis of the right iliac fossa was performed. The primary outcome was to compare the diagnosis performance of bedside ultrasound and clinical-laboratory examination to detect a surgical pathology. Two Emergency Physicians who did not participate in the study made the final diagnosis (i.e., surgical or non-surgical pathology) by reviewing the entire medical chart of each patient. Results From January 2011 to July 2013, 158 patients with a median age of 17 [13–32] years were analyzed. The diagnosed cases were: appendicitis (53), non-specific abdominal pain (48), lymphadenitis (22), ileitis (11), complicated ovarian cysts (7), neoplasias (5), inflammatory or infectious colitis (5), inguinal herniations (3), bowel obstructions (2), and salpingitis (2). The accuracy of ultrasound diagnoses was 0.89 (95% CI 0.84–0.94) versus 0.70 (95% CI 0.57–0.82) for diagnoses based on clinical-laboratory examination only (p
Robert M Eisenstein - One of the best experts on this subject based on the ideXlab platform.
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an evaluation of the accuracy of Emergency Physician activation of the cardiac catheterization laboratory for patients with suspected st segment elevation myocardial infarction
Annals of Emergency Medicine, 2010Co-Authors: Matthew L Wong, Robert M EisensteinAbstract:Study objective Current recommendations indicate that Emergency Physicians should activate cardiac catheterization laboratory personnel by a single page for ST-segment elevation myocardial infarction (STEMI) patients. We assessed the accuracy of Emergency Physician cardiac catheterization laboratory activations, angiographic findings, outcomes, and treatment times among patients with and without STEMI. Methods We classified the appropriateness and outcomes of consecutive Emergency Physician STEMI pages between June 2006 and September 2008. Emergency Physician activations of the cardiac catheterization laboratory were classified according to the findings of the initial ECG compared with cardiology interpretation for the presence of STEMI and presence of coronary disease. Results During a 27-month period, Emergency Physician activation of the cardiac catheterization laboratory occurred 249 times. There were 188 (76%) patients with a true STEMI, of whom 13 did not receive Emergency angiography. Of the 37 (15%) patients who had ECG findings meeting STEMI criteria and who ultimately did not have myocardial necrosis and underwent Emergency angiography, 12 had significant disease and 5 had revascularization performed. Eleven patients had ECGs concerning for but not meeting STEMI criteria; all had Emergency angiography (n=11) or received a diagnosis of non-STEMI (n=6). Only 13 patients were considered as having received unnecessary cardiac catheterization laboratory activations (5.2%) in which Emergency angiography was not performed and myocardial infarction was excluded. Conclusion A significant number of Emergency Physician STEMI cardiac catheterization laboratory activations are for patients who did not meet standard STEMI criteria. However, most had ECG findings and symptoms that lead to Emergency angiography, had significant disease, or were diagnosed with non-STEMI. Only a small percentage of patients received unnecessary cardiac catheterization laboratory activations. Our findings support current recommendations for Emergency Physician cardiac catheterization laboratory activation for potential STEMI patients.
Rita K Cydulka - One of the best experts on this subject based on the ideXlab platform.
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variables associated with discordance between Emergency Physician and neurologist diagnoses of transient ischemic attacks in the Emergency department
Annals of Emergency Medicine, 2012Co-Authors: Jon W Schrock, Michael Glasenapp, Aaron Victor, Theodore Losey, Rita K CydulkaAbstract:Study objective Transient ischemic attack is a common clinical diagnosis in Emergency department (ED) patients with acute neurologic complaints. Accurate diagnosis of transient ischemic attack is essential to help guide evaluation and avoid treatment delays. We seek to determine the prevalence of discordant diagnosis for patients receiving an ED diagnosis of transient ischemic attack compared with neurologist final diagnosis. Secondary goals are to evaluate the influence of atypical transient ischemic attack symptoms, the ABCD2 score, and Emergency Physician experience on discordant diagnoses. Methods We performed a retrospective cohort study evaluating all ED patients receiving a diagnosis of transient ischemic attack during a 4-year period. The Emergency Physician diagnosis was compared with that of the neurologist. The neurologist's final diagnosis was considered the criterion standard diagnosis. Subject demographic and clinical information was collected with a structured instrument. The following atypical symptoms present at the ED evaluation were evaluated with logistic regression: headache, tingling, involuntary movement, seeing flashing lights or wavy lines, dizziness, confusion, incontinence, and ABCD2 score of 4 or greater. Bivariate analysis was used to evaluate the influence of Emergency Physician experience (≤6 years versus >6 years) on discordant diagnosis. Odds ratios (ORs) and proportions are reported with 95% confidence intervals (CIs), interquartile range was used where appropriate. Results We evaluated 436 subjects, of whom 7 were excluded, allowing 429 subjects for evaluation. Of these individuals, 156 (36%; 95% CI 32% to 41%) received a discordant diagnosis. The median Emergency Physician time in clinical practice was 6 years (interquartile range 2 to 12 years). Features associated with a discordant transient ischemic attack diagnosis included headache (OR 2.52; 95% CI 1.59 to 3.99), involuntary movement (OR 3.19; 95% CI 1.35 to 7.54), and dizziness (OR 1.92; 95% CI 1.22 to 3.02). Incontinence, confusion, and seeing wavy lines or flashing lights were not significantly associated with a discordant diagnosis. Patients with tingling and a high ABCD2 score had an increased odds of concordant transient ischemic attack diagnosis (OR 0.54, 95% CI 0.32 to 0.92; OR 0.53, 95% CI 0.35 to 0.82, respectively). Conclusion Discordant diagnoses between Emergency Physicians and neurologists were observed in 36% of patients. The presence of headache, involuntary movement, and dizziness predicted discordant diagnoses, whereas the presence of tingling and an increased ABCD2 score predicted concordant transient ischemic attack diagnosis.
Jeaneudes Bourcier - One of the best experts on this subject based on the ideXlab platform.
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diagnostic performance of abdominal point of care ultrasound performed by an Emergency Physician in acute right iliac fossa pain
Critical Ultrasound Journal, 2018Co-Authors: Jeaneudes Bourcier, Emeric Gallard, Jeanphilippe Redonnet, Magali Majourau, Dominique Deshaie, Jeanmarie Bourgeois, Didier Garnier, Thomas GeeraertsAbstract:Right iliac fossa abdominal pain is a common reason for Emergency ward admissions, its etiology is difficult to diagnose. It can be facilitated by an imaging examination, such as a Computerized Tomography scan which exposes the patient to ionizing radiation and implies delays. A bedside ultrasound performed by Emergency Physicians could avoid these issues. The aim of our study was to assess the performance of ultrasound carried out at the patient’s bedside by an Emergency Physician compared with a clinical-laboratory examination for the diagnosis of a surgical pathology in right iliac fossa pain. This is a single-center prospective cohort study conducted in an Emergency Department receiving 19,000 patients per year. All patients presenting pain in the right iliac fossa were included by four (out of ten) Emergency Physicians certified in an ultrasound examination. A full grid pattern scan ultrasound of the abdominal cavity with analysis of the right iliac fossa was performed. The primary outcome was to compare the diagnosis performance of bedside ultrasound and clinical-laboratory examination to detect a surgical pathology. Two Emergency Physicians who did not participate in the study made the final diagnosis (i.e., surgical or non-surgical pathology) by reviewing the entire medical chart of each patient. From January 2011 to July 2013, 158 patients with a median age of 17 [13–32] years were analyzed. The diagnosed cases were: appendicitis (53), non-specific abdominal pain (48), lymphadenitis (22), ileitis (11), complicated ovarian cysts (7), neoplasias (5), inflammatory or infectious colitis (5), inguinal herniations (3), bowel obstructions (2), and salpingitis (2). The accuracy of ultrasound diagnoses was 0.89 (95% CI 0.84–0.94) versus 0.70 (95% CI 0.57–0.82) for diagnoses based on clinical-laboratory examination only (p < 0.001). Bedsides, ultrasound allows an accurate diagnosis of a surgical pathology in 89% of cases, which is more efficient than the clinical-laboratory examination.
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Diagnostic performance of abdominal point of care ultrasound performed by an Emergency Physician in acute right iliac fossa pain
SpringerOpen, 2018Co-Authors: Jeaneudes Bourcier, Emeric Gallard, Jeanphilippe Redonnet, Magali Majourau, Dominique Deshaie, Jeanmarie Bourgeois, Didier Garnier, Thomas GeeraertsAbstract:Abstract Background Right iliac fossa abdominal pain is a common reason for Emergency ward admissions, its etiology is difficult to diagnose. It can be facilitated by an imaging examination, such as a Computerized Tomography scan which exposes the patient to ionizing radiation and implies delays. A bedside ultrasound performed by Emergency Physicians could avoid these issues. The aim of our study was to assess the performance of ultrasound carried out at the patient’s bedside by an Emergency Physician compared with a clinical-laboratory examination for the diagnosis of a surgical pathology in right iliac fossa pain. Methods This is a single-center prospective cohort study conducted in an Emergency Department receiving 19,000 patients per year. All patients presenting pain in the right iliac fossa were included by four (out of ten) Emergency Physicians certified in an ultrasound examination. A full grid pattern scan ultrasound of the abdominal cavity with analysis of the right iliac fossa was performed. The primary outcome was to compare the diagnosis performance of bedside ultrasound and clinical-laboratory examination to detect a surgical pathology. Two Emergency Physicians who did not participate in the study made the final diagnosis (i.e., surgical or non-surgical pathology) by reviewing the entire medical chart of each patient. Results From January 2011 to July 2013, 158 patients with a median age of 17 [13–32] years were analyzed. The diagnosed cases were: appendicitis (53), non-specific abdominal pain (48), lymphadenitis (22), ileitis (11), complicated ovarian cysts (7), neoplasias (5), inflammatory or infectious colitis (5), inguinal herniations (3), bowel obstructions (2), and salpingitis (2). The accuracy of ultrasound diagnoses was 0.89 (95% CI 0.84–0.94) versus 0.70 (95% CI 0.57–0.82) for diagnoses based on clinical-laboratory examination only (p
Matthew L Wong - One of the best experts on this subject based on the ideXlab platform.
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an evaluation of the accuracy of Emergency Physician activation of the cardiac catheterization laboratory for patients with suspected st segment elevation myocardial infarction
Annals of Emergency Medicine, 2010Co-Authors: Matthew L Wong, Robert M EisensteinAbstract:Study objective Current recommendations indicate that Emergency Physicians should activate cardiac catheterization laboratory personnel by a single page for ST-segment elevation myocardial infarction (STEMI) patients. We assessed the accuracy of Emergency Physician cardiac catheterization laboratory activations, angiographic findings, outcomes, and treatment times among patients with and without STEMI. Methods We classified the appropriateness and outcomes of consecutive Emergency Physician STEMI pages between June 2006 and September 2008. Emergency Physician activations of the cardiac catheterization laboratory were classified according to the findings of the initial ECG compared with cardiology interpretation for the presence of STEMI and presence of coronary disease. Results During a 27-month period, Emergency Physician activation of the cardiac catheterization laboratory occurred 249 times. There were 188 (76%) patients with a true STEMI, of whom 13 did not receive Emergency angiography. Of the 37 (15%) patients who had ECG findings meeting STEMI criteria and who ultimately did not have myocardial necrosis and underwent Emergency angiography, 12 had significant disease and 5 had revascularization performed. Eleven patients had ECGs concerning for but not meeting STEMI criteria; all had Emergency angiography (n=11) or received a diagnosis of non-STEMI (n=6). Only 13 patients were considered as having received unnecessary cardiac catheterization laboratory activations (5.2%) in which Emergency angiography was not performed and myocardial infarction was excluded. Conclusion A significant number of Emergency Physician STEMI cardiac catheterization laboratory activations are for patients who did not meet standard STEMI criteria. However, most had ECG findings and symptoms that lead to Emergency angiography, had significant disease, or were diagnosed with non-STEMI. Only a small percentage of patients received unnecessary cardiac catheterization laboratory activations. Our findings support current recommendations for Emergency Physician cardiac catheterization laboratory activation for potential STEMI patients.