High positive computed tomography yields in the emergency department might not be a positive finding

Swartzberg, Kylen; Goldstein, Lara Nicole

doi:10.7196/samj.2018.v108i3.12635

Cited by 6 publications

(17 citation statements)

References 25 publications

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“…The positivity rate may be considered too high, indicating likely underdiagnosis because of resource constraints. 1 The audit showed that the waiting time for CT scans was dramatically reduced, whilst the number of CT scans remained more or less the same and the number of inappropriate requests was also reduced. All CT scan bookings were deemed appropriate (Table 1).…”

Section: Intervention: Access and Governance Of A Ct Scan Servicementioning

confidence: 99%

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The contribution of family physicians in coordinating care and improving access at district hospitals: The False Bay experience, South Africa

Rossouw

Lalkhen²,

Adamson

et al. 2021

African Journal of Primary Health Care & Family Medicine

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This short report describes three family physicians (FP)-led clinical governance interventions to strengthen the care access and coordination in an urban district hospital in Cape Town, South Africa. The actual experiences and their effects on health services are captured here. The report also describes a range of interventions from enhanced access to timely computer tomographic scans to determine definitive care, to creating a local referral forum between levels of care, which resulted in a renewed appreciation for the scope of services and illness burden managed by the district health system and to the establishment of an onsite echocardiology service at the local district hospital to enhance the identified burden of disease of the local community. Each of these interventions were planned and implemented based on local data in partnership with the team members at the different levels of care. By applying an inclusive and distributed leadership style as informed by care access to scarce resources was better coordinated for the local communities served. The importance of the building trusting relationships between FPs and referral hospital colleagues cannot be overemphasised. Family physicians should be integrated and collaborated in the clinical governance platforms across levels of care. The FP’s roles as primary care consultant and clinical governance leader are pivotal in enhancing service delivery efficiency and in providing quality healthcare.

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Section: Intervention: Access and Governance Of A Ct Scan Servicementioning

confidence: 99%

“…The positivity rate may be considered too high, indicating likely underdiagnosis because of resource constraints. 1 …”

Section: Example 1: Access To and Clinical Governance Of Computer Tomographic Scansmentioning

confidence: 99%

The contribution of family physicians in coordinating care and improving access at district hospitals: The False Bay experience, South Africa

Rossouw

Lalkhen²,

Adamson

et al. 2021

African Journal of Primary Health Care & Family Medicine

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“…EPs prefer the least invasive methods for diagnosis. [ 1 ] X-ray radiography, ultrasonography, computed tomography (CT), and magnetic resonance imaging are frequently used in EDs. The use of CT in EDs is widespread, as CT is a fast imaging method and expedites ED procedures.…”

Section: Introductionmentioning

confidence: 99%

“…The use of CT in EDs is widespread, as CT is a fast imaging method and expedites ED procedures. [ 1 2 ] Although CT has become increasingly common, the accurate interpretation of CT requires a high level of knowledge. To avoid misinterpretations, the radiologist interpreting the CT scan needs to be familiar with the clinical condition of the patient.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of emergency physicians’ interpretation of computed tomography for urgent-emergent diagnoses in nontraumatic cases

Avcı

Karakoyun

Kozacı

et al. 2022

Turkish Journal of Emergency Medicine

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OBJECTIVE: The aim of this study is to evaluate the accuracy levels of the emergency physicians (EPs) managing the patient in the interpretation of the urgent-emergent pathological findings in thoracic and abdominal computed tomography (CT) scans. METHODS: The EPs interpreted the CT scans of patients who visited the emergency department because of nontraumatic causes. Then, a radiology instructor made final assessments of these CT scans. Based on the interpretation of the radiology instructor, the false-positive rate, false-negative rate, sensitivity, specificity, positive predictive value, negative predictive value, and kappa coefficient (κ) of the EPs’ interpretations of the CT scans were calculated. RESULTS: A total of 268 thoracics and 185 abdominal CT scans were assessed in our study. The overall sensitivity and specificity of the EPs’ interpretation of the thoracic CT scans were 90% and 89%, respectively, whereas the abdominal CT interpretation was 88% and 86%, respectively. There was excellent concordance between the EPs and the radiology instructor with regard to the diagnoses of pneumothorax, pulmonary embolism, pleural effusion, parenchymal pathology, and masses (κ: 0.90, κ: 0.87, κ: 0.71, κ: 0.79, and κ: 0.91, respectively) and to the diagnoses of intraabdominal free fluid, intraabdominal free gas, aortic pathology, splenic pathology, gallbladder pathology, mesenteric artery embolism, appendicitis, gynecological pathology, and renal pathology (κ: 1, κ: 0.92, κ: 0.96, κ: 0.88, κ: 0.80, κ: 0.79, κ: 0.89, κ: 0.88, and κ: 0.82, respectively). CONCLUSION: The EPs are successful in the interpretation of the urgent-emergent pathological findings in thoracic and abdominal CT scans.

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“…In the USA, usage increased by more than 300% from 1996 to 2007 with a more recent study in Taiwan showing an increase of 160% from 2009 to 2013 [5,6]. In South Africa, 45 million people utilize public sector healthcare services where there are 5 CT scanning machines available per one million population -it is a finite and costly resource [7][8][9]. This is dwarfed by developed countries such as Japan and the USA who have 111 and 42 CT scanners per million population, respectively [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

CT Utilization in a Level One Trauma Center in South Africa

Goldstein¹,

Dawadi²,

Viljoen³

2022

Cureus

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IntroductionComputed tomography (CT) imaging forms an important component in the evaluation and management of patients with traumatic injuries. Many South African emergency departments (EDs) have a significant trauma-related workload, especially in the public sector, where there are limitations in resources relating to CT scanners. It is important to gauge the impact of traumatic injuries on CT utilization. The primary objectives were to quantify the number and type of CT imaging studies trauma patients received, as well as to determine the frequency of radiologically significant findings in a level one trauma center. The secondary objectives were to determine the CT utilization rate and describe the demographics of patients who received imaging. MethodsThis was a retrospective, quantitative, descriptive, cross-sectional study undertaken over two months at the level one trauma center of a tertiary, academic, public sector teaching hospital in Johannesburg, South Africa. The radiology department's picture archiving and communication system (PACS) was used to evaluate the reports of trauma patients who were referred for a CT scan. The trauma center register was used to calculate the CT utilization rate. ResultsThere were 5,058 trauma patients seen in the two months. A total of 1,277 CT scans were performed on 843 patients. CT brain accounted for 52% of all scans performed. Radiologically significant findings were demonstrated in 407 scans (354 patients), i.e. 31.9% of scans and 42% of patients. CT chest and peripheral angiogram demonstrated radiologically significant findings in 60.5% and 50.9% of scans respectively. Assault accounted for 55.8% of the injuries sustained and road traffic accidents accounted for 33.2%. The overall CT utilization rate was 16.7% i.e. 843 out of the 5,058 trauma patients underwent a CT scan. ConclusionsSouth Africa has a substantial trauma burden which commonly necessitates CT utilization. It is concerning that blunt and penetrating assault continues to dominate these traumatic presentations. Worldwide, there is a broad range of described CT utilization rates and the findings at this level one trauma center fall within that range. ED clinicians are encouraged to continue carefully using this scarce resource in the trauma setting.

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High positive computed tomography yields in the emergency department might not be a positive finding

Cited by 6 publications

References 25 publications

The contribution of family physicians in coordinating care and improving access at district hospitals: The False Bay experience, South Africa

The contribution of family physicians in coordinating care and improving access at district hospitals: The False Bay experience, South Africa

Accuracy of emergency physicians’ interpretation of computed tomography for urgent-emergent diagnoses in nontraumatic cases

CT Utilization in a Level One Trauma Center in South Africa

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