Turkish Journal of Emergency Medicine最新文献_第10页

Defective barcode sign – A newer sonographic sign in hydropneumothorax 条形码缺陷征象——气胸积液的一种较新的超声征象

IF 0.9 Q2 Medicine

Turkish Journal of Emergency Medicine

Pub Date : 2022-04-11 DOI: 10.4103/2452-2473.342809

S. Mahalingam, G. Rajendran, A. Sadasivam, Manu Ayyan, V. Pillai

Effusive pneumothorax can be hemopneumothorax, pyopneumothorax, or hydropneumothorax depending on the type of fluid compartment within the pleural cavity. Hydropneumothorax is the abnormal collection of air and serous fluid within the pleural cavity. Here, we report a case of a 34-year-old male who presented to the emergency department with cough and breathlessness. We did bedside point-of-care ultrasound-assisted clinical evaluation as the patient was vitally unstable, which showed “hydro point” and “defective barcode sign,” which suggested hydropneumothorax. We present these clinical evaluation details, imaging/sonographic findings, and patient management in this case report.

根据胸膜腔内液体腔的类型，积液性气胸可分为血气胸、脓气胸或气胸积液。气胸是胸膜腔内空气和浆液的异常聚集。在这里，我们报告一个34岁的男性谁提出了咳嗽和呼吸困难的急诊科。由于患者生命不稳定，我们做了床边点超声辅助临床评估，显示“hydro point”和“defective barcode sign”，提示气胸积液。我们在本病例报告中介绍这些临床评估细节，影像学/超声检查结果和患者管理。

引用次数: 1

Cardiac tamponade due to right atrial rupture 右心房破裂引起的心包填塞

IF 0.9 Q2 Medicine

Turkish Journal of Emergency Medicine

Pub Date : 2022-04-11 DOI: 10.4103/2452-2473.342803

G. Rajendran, G. Babu, Vinodha Chandrasekar, Rajeshwari Kagne, B. Nathan

Cardiac tamponade is a cardiac emergency that requires urgent intervention. Cardiac tamponade due to penetrating cardiac injury requires urgent thoracotomy. As per the guidelines, pericardiocentesis can be done as a bridge to thoracotomy. However, no clear guidelines exist on the management of cardiac tamponade due to blunt cardiac injury. In the following case report, we propose a management plan for blunt cardiac injury in the emergency department. In the following case report, we describe a patient with a road traffic accident who had a blunt cardiac injury and had cardiac tamponade for whom we did not do emergency pericardiocentesis. Instead, we managed the patient with iv fluids and blood transfusion and the patient was taken up for immediate emergency thoracotomy. Not all cardiac tamponade requires pericardiocentesis. Cardiac tamponade due to injury to the low-pressure system can be best managed by initial resuscitation followed by emergency thoracotomy. We also propose a management plan for managing a patient with cardiac tamponade due to blunt cardiac injury when the injury can be visible in the low-pressure chambers.

心脏填塞是一种需要紧急干预的心脏急症。由于心脏穿透性损伤导致的心包填塞需要紧急开胸。根据指南，心包穿刺术可以作为开胸手术的桥梁。然而，对于钝性心脏损伤引起的心包填塞的处理尚无明确的指导方针。在以下的病例报告中，我们提出了在急诊科钝性心脏损伤的处理方案。在下面的病例报告中，我们描述了一位道路交通事故患者，他有钝性心脏损伤和心脏填塞，我们没有对他进行紧急心包穿刺术。相反，我们对病人进行了静脉输液和输血，并立即对病人进行了紧急开胸手术。并非所有的心包填塞都需要心包穿刺。由于低压系统损伤引起的心包填塞可以通过初始复苏和紧急开胸来最好地处理。我们还提出了一个管理计划，处理钝性心脏损伤引起的心包填塞，当损伤可以在低压室中看到时。

引用次数: 0

Auricular avulsion injuries: Literature review and management algorithm 耳穴撕脱伤:文献回顾及处理方法

IF 0.9 Q2 Medicine

Turkish Journal of Emergency Medicine

Pub Date : 2022-04-11 DOI: 10.4103/2452-2473.342811

Mohamed A. Al-Ali, F. Abu-Zidan

Traumatic ear avulsion (TEA) may have tremendous psychological consequences if not managed properly. There are no clear guidelines on the surgical management of these injuries, especially in developing countries where microsurgical facilities are lacking. We aimed to review the literature on surgical management of TEA with the main focus on direct re-attachment (DR) so as to develop a surgical management algorithm that can be applied in the absence of microsurgical facilities. We performed an extensive review of the relevant English literature on papers indexed in PubMed describing TEA repaired with DR without restriction to a specific publication time window. A total of 28 cases in 18 publications were reviewed and analyzed. Our results indicate that in the acute setting with no available microvascular expertise, DR of auricular avulsion injuries can be better than other nonmicrosurgical techniques in generating good esthetic results, especially in incomplete auricular avulsion and small segment avulsion. The operative approach depends on the clinical setting. DR of the auricular avulsion injuries is an accepted approach. It produces good cosmetic outcomes while preserving the auricular area for future reconstruction in case of re-attachment failure.

外伤性耳部撕脱术(TEA)如果处理不当，可能会造成严重的心理后果。对于这些损伤的外科治疗没有明确的指导方针，特别是在缺乏显微外科设备的发展中国家。我们旨在回顾有关TEA手术管理的文献，主要关注直接再附着(DR)，以开发一种可以在缺乏显微外科设备的情况下应用的手术管理算法。我们对PubMed检索的相关英文文献进行了广泛的回顾，这些文献描述了用DR修复TEA，不受特定出版时间窗口的限制。本文对18篇文献中的28例病例进行了综述和分析。我们的研究结果表明，在没有微血管专业知识的急性情况下，耳廓撕脱伤的DR比其他非显微手术技术更能产生良好的美学效果，特别是在不完全性耳廓撕脱伤和小段撕脱伤中。手术入路取决于临床情况。耳部撕脱伤的DR是一种公认的方法。它产生了良好的美容效果，同时保留了耳廓区域，以便在再植失败的情况下将来重建。

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引用次数: 2

A case report on rectus sheath hematoma in an intubated COVID-19 patient 新型冠状病毒肺炎插管患者直肌鞘血肿1例报告

IF 0.9 Q2 Medicine

Turkish Journal of Emergency Medicine

Pub Date : 2022-04-11 DOI: 10.4103/2452-2473.342807

Bhasyani Nagaretnam

Rectus sheath hematoma (RSH) is a life-threatening condition. Its pathology lies behind its unique anatomy. Critically ill COVID-19 patients are managed in the emergency department for longer periods while awaiting critical care admission. Therefore, more complex procedures such as prone positioning are performed in the emergency department to ensure patient care continues. We report this case of RSH in an intubated critically ill COVID-19 patient requiring prone position. During her stay in the Emergency Department Acute Care Unit, she developed anemia, uremia, and worsening hypoxia. Emergency contrast-enhanced computed tomography leads to our diagnosis of RSH. She was treated with a conservative approach and blood transfusion. We would like to highlight this case for its diagnostic complexity since this ventilated patient required both biochemical and radiological markers to diagnose RSH in combination with high suspicion levels. RSH must be considered in patients with risk factors such as prone position and anticoagulant usage. Last, a holistic approach to critically ill patients will not only benefit patients but also health-care profession. The direction of care should be decided based on the patient's condition, imaging, and hospital resources.

直肌鞘血肿(RSH)是一种危及生命的疾病。它独特的解剖结构背后隐藏着病理学。COVID-19危重患者在等待重症监护住院期间，在急诊科接受更长时间的管理。因此，更复杂的程序，如俯卧位在急诊科进行，以确保病人护理的继续。我们报告了一例需要俯卧位的插管危重COVID-19患者的RSH。在急诊科急症监护室住院期间，她出现贫血、尿毒症和缺氧恶化。紧急对比增强计算机断层扫描导致我们诊断为RSH。她接受了保守治疗和输血。我们想强调这个病例的诊断复杂性，因为这个通气的病人需要生化和放射学标记来诊断RSH，并结合高怀疑水平。有俯卧位和使用抗凝剂等危险因素的患者必须考虑RSH。最后，对危重患者采取全面的治疗方法，不仅有利于患者，也有利于医疗保健行业。护理方向应根据患者的病情、影像学和医院资源来决定。

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引用次数: 3

Manual versus mechanical chest compression in in-hospital cardiac arrest: A retrospective cohort in emergency department patients 手动与机械胸外按压在院内心脏骤停:回顾性队列急诊科患者

IF 0.9 Q2 Medicine

Turkish Journal of Emergency Medicine

Pub Date : 2022-04-11 DOI: 10.4103/2452-2473.342808

A. Şener, G. P. Günaydın, F. Tanrıverdi, Ayhan Özhasenekler, Ş. Gökhan, Gülhan Kurtoğlu Çelik, Özcan Sağlam, Nihal Ertürk

OBJECTIVE: Mechanical chest compression (CC) devices are frequently used in in-hospital and out-of-hospital settings. In this study, mechanical and manual CC in in-hospital cardiac arrest was compared in terms of survival. METHODS: Adult patients who were admitted to the emergency department (ED) for 2 years period and had cardiac arrest in the ED were included in this retrospective, observational study. Return of spontaneous circulation (ROSC), 7-day and 30-day survival and hospital discharge data were compared between the two groups of patients who underwent manual CC and those who had mechanical CC with the Lund University Cardiac Assist System-2 device. RESULTS: Although the rate of ROSC in the mechanical CC group was lower than in the manual CC group, this difference was not statistically significant (41.7% vs. 50.4%; P = 0.133). The 7-day survival rate was found to be statistically significantly higher in the mechanical CC group (19.4% vs. 8.9%; P = 0.012). The 30-day survival rate was also found to be high in the mechanical CC group, but this difference was not statistically significant (10.6% vs. 7.3%; P = 0.339). CONCLUSION: In the light of these results, we can say that the use of piston-based mechanical CC devices in ED may be beneficial. More reliable results can be obtained with a prospective study to be performed in the ED.

目的:机械胸外按压(CC)装置在医院内外的应用非常广泛。在这项研究中，比较了院内心脏骤停患者的机械和手动CC的生存率。方法:回顾性观察性研究纳入了在急诊科(ED)住院2年并在ED发生心脏骤停的成年患者。比较两组患者的自发循环恢复(ROSC)、7天和30天的生存和出院数据，这两组患者分别采用隆德大学心脏辅助系统-2装置进行手动CC和机械CC。结果:虽然机械CC组ROSC发生率低于手动CC组，但差异无统计学意义(41.7% vs 50.4%;P = 0.133)。机械CC组7天生存率显著高于机械CC组(19.4% vs. 8.9%;P = 0.012)。机械CC组的30天生存率也较高，但差异无统计学意义(10.6% vs. 7.3%;P = 0.339)。结论:基于这些结果，我们可以说在ED中使用活塞式机械CC装置可能是有益的。在急诊科进行前瞻性研究可以获得更可靠的结果。

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引用次数: 0

Epidemiology of mass casualty incidents in a tertiary care trauma center in eastern India: A retrospective observational study 印度东部三级护理创伤中心大规模伤亡事件的流行病学:一项回顾性观察研究

IF 0.9 Q2 Medicine

Turkish Journal of Emergency Medicine

Pub Date : 2022-04-11 DOI: 10.4103/2452-2473.342806

C. Mohanty, R. Radhakrishnan, Shine Stephen, Mantu Jain, Asha P. Shetty, Alwin Issac, I. Shaji, Sebastian Chakola

OBJECTIVES: Disasters and mass casualty incidents (MCIs) that cause substantial mortality and morbidity have been increasing worldwide. The emergency department (ED) services manage MCIs by optimizing triage and providing health care with required resources. The present study attempted to describe the epidemiological characteristics and outcomes of MCIs presenting to the ED. METHODS: The present retrospective observational study was conducted at the ED of a tertiary care hospital on patients of MCI for 4 years from 2017 to 2021. The data were extracted from the ED disaster records and other paper-based patient records. Information on patient demography, date and time of arrival, mode of transport, method of arrival (direct or referral), type and mechanism of MCI, ED management, and outcome were recorded. Statistical analysis was performed using R, version 4.1.0. RESULTS: Analysis of 21 MCIs was conducted. Road traffic accidents (RTAs) were the predominant cause of MCIs. The majority of MCI victims, except for those of blast injuries, were men. The victims in medical emergencies were significantly younger than those in other MCI groups (P < 0.001). The majority of patients were brought to ED through ambulance services (n = 120 [47.1%]), followed by private vehicles (n = 112 [44.2%]). Most of the MCI victims (n = 143 [56.2%]) were brought to the ED during evening hours (4 pm–8 pm). The majority of victims belonged to the “Red” triage category (n = 110 [43.3%]). The injury severity score was significantly higher (P = 0.014) in the disaster group than in other trauma MCI groups (20 vs. 17). Autorickshaw occupants were the most common victims of mass casualty RTAs (n = 38 [40%]). Suturing (n = 97 [50%]) and dressing (n = 167 [88%]) were the most common ED procedures required by the victims of trauma MCIs. Of the total, 167 (66%) patients were discharged from the ED, 47 (19%) patients were admitted to wards, 13 (5%) patients were admitted to intensive care units, and 24 (9%) patients got referred to other centers. In addition, two patients died in the ED during treatment, whereas one patient was brought dead. CONCLUSIONS: RTAs dominate the MCIs and are affecting the young producative male population. The present study exhibited the severity of the cases in MCIs and their impact in the health-care setting, therefore signifying the importance of standardized MCI management protocols.

目标:在世界范围内，造成大量死亡率和发病率的灾害和大规模伤亡事件(MCIs)一直在增加。急诊科(ED)服务通过优化分类和提供医疗保健所需的资源来管理mci。本研究试图描述MCI在急诊科的流行病学特征和结局。方法:本回顾性观察性研究是在一家三级医院的急诊科对2017年至2021年4年的MCI患者进行的。数据是从急诊科灾难记录和其他纸质病人记录中提取的。记录患者人口统计、到达日期和时间、交通方式、到达方式(直接或转诊)、MCI类型和机制、ED管理和结果等信息。统计分析使用R 4.1.0版本。结果:对21例MCIs进行了分析。道路交通事故(rta)是MCIs的主要原因。除爆炸伤外，MCI的大多数受害者都是男性。急诊患者年龄明显低于其他MCI组(P < 0.001)。大多数患者通过救护车(n = 120[47.1%])被送往急诊科，其次是私家车(n = 112[44.2%])。大多数MCI患者(143例[56.2%])是在晚上(下午4点至8点)被送到急诊科的。大多数受害者属于“红色”分类(n = 110[43.3%])。灾难组损伤严重程度评分显著高于其他创伤MCI组(20比17)(P = 0.014)。机动三轮车乘客是大规模伤亡rta最常见的受害者(n = 38[40%])。缝合(n = 97[50%])和包扎(n = 167[88%])是创伤性MCIs受害者最常见的ED程序。其中，167例(66%)患者从急诊科出院，47例(19%)患者入住病房，13例(5%)患者入住重症监护病房，24例(9%)患者转诊至其他中心。此外，两名患者在治疗期间在急诊科死亡，而一名患者死亡。结论:rta在MCIs中占主导地位，并影响着年轻的育龄男性人群。本研究显示了MCI病例的严重程度及其对卫生保健环境的影响，因此表明了标准化MCI管理协议的重要性。

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引用次数: 1

Association between calcium administration and outcomes during adult cardiopulmonary resuscitation at the emergency department 急诊成人心肺复苏过程中钙的使用与结果的关系

IF 0.9 Q2 Medicine

Turkish Journal of Emergency Medicine

Pub Date : 2022-04-11 DOI: 10.4103/2452-2473.342805

Wachira Wongtanasarasin, Nat Ungrungseesopon, Nutthida Namsongwong, Pongsatorn Chotipongkul, Onwara Visavakul, Napatsakorn Banping, Worapot Kampeera, Phichayut Phinyo

OBJECTIVES: Calcium administration during cardiac arrest is limited in some circumstances, mainly due to lack of consistent evidence. This study aims to investigate whether calcium therapy administered during cardiac arrest at the Emergency Department is associated with good outcomes, including the probability of return of spontaneous circulation (ROSC), survival to hospital admission, survival to hospital discharge, and favorable neurological outcome at discharge. METHODS: We retrospectively reviewed 599 consecutive adult cardiac arrest events between 2016 and 2018. The primary outcome was the ROSC rate. Secondary outcomes included survival to hospital admission, survival to hospital discharge, and favorable neurologic outcome at hospital discharge. Multivariable logistic regression with inverse probability of treatment weighting was analyzed to examine the association between calcium administration and outcomes. RESULTS: Of 599 events, calcium was administered in 72 (12%) cases. The use of calcium during cardiopulmonary resuscitation (CPR) after adjusting for confounding factors was not associated with any better outcomes, including ROSC (adjusted odds ratio (aOR) 0.53, 95% confidence interval [CI] 0.24–1.17), survival to hospital admission (aOR 1.07, 95% CI 0.47–2.41), survival to hospital discharge (aOR 1.93, 95% CI 0.43–8.56), and favorable neurological outcome (aOR 6.60, 95% CI 0.72–60.74). Besides, calcium use in traumatic cardiac arrest patients was associated with unfavorable outcomes, including ROSC (aOR 0.02, 95% CI 0.00–0.09) and survival to hospital admission (aOR 0.16, 95% CI 0.03–0.84). CONCLUSION: The use of calcium during an adult cardiac arrest was not associated with better outcomes. Although associations drawn from this study did not indicate the causality, given calcium during CPR was linked to poorer outcomes in traumatic cardiac arrest patients, including ROSC and survival to hospital admission.

目的:心脏骤停期间钙的给药在某些情况下是有限的，主要是由于缺乏一致的证据。本研究旨在探讨急诊科心脏骤停期间给予钙治疗是否与良好的预后相关，包括自发循环恢复(ROSC)的概率、入院生存、出院生存以及出院时良好的神经系统预后。方法:我们回顾性分析了2016年至2018年间599例连续的成人心脏骤停事件。主要结果是ROSC率。次要结局包括住院时的生存、出院时的生存和出院时良好的神经预后。采用多变量logistic回归分析治疗权重的逆概率，以检验钙给药与预后之间的关系。结果:在599例事件中，72例(12%)给予钙。校正混杂因素后，心肺复苏(CPR)期间钙的使用与任何较好的结果无关，包括ROSC(校正优势比(aOR) 0.53, 95%可信区间[CI] 0.24-1.17)、生存至住院(aOR 1.07, 95% CI 0.47-2.41)、生存至出院(aOR 1.93, 95% CI 0.43-8.56)和良好的神经预后(aOR 6.60, 95% CI 0.72-60.74)。此外，外伤性心脏骤停患者的钙使用与不良结局相关，包括ROSC (aOR为0.02,95% CI为0.00-0.09)和住院前的生存(aOR为0.16,95% CI为0.03-0.84)。结论:在成人心脏骤停期间使用钙与更好的预后无关。虽然从本研究中得出的关联并没有表明因果关系，但在心肺复苏术中给予钙与创伤性心脏骤停患者较差的预后有关，包括ROSC和住院存活率。

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引用次数: 4

The effect of calcium gluconate in the treatment of hyperkalemia 葡萄糖酸钙治疗高钾血症的效果

IF 0.9 Q2 Medicine

Turkish Journal of Emergency Medicine

Pub Date : 2022-04-11 DOI: 10.4103/2452-2473.342812

N. G. Celebi Yamanoglu, Adnan Yamanoğlu

OBJECTIVES: Intravenous (IV) calcium salts are routinely recommended as a cardio-protective therapy in the emergency treatment of severe hyperkalemia. However, this recommendation is supported by a low level of evidence and is anecdotal. The aim of this study is to determine the effectiveness of IV Calcium (Ca) gluconate in the treatment of hyperkalemia. MATERIALS AND METHODS: Patients with hyperkalemia and with the electrocardiogram (ECG) changes due to hyperkalemia over a 1 year period were included in this prospective observational study. Patients’ ECGs were measured, before and after IV Ca-gluconate treatment and after normalization of potassium levels. Wilcoxon test and McNemar's test were used to compare the ECG parameters before and after Ca-gluconate therapy. RESULTS: The mean potassium value of 111 patients who met the inclusion criteria was 7.1 ± 0.6 mmol/l. In this study, a total of 243 ECG pathology related to hyperkalemia, 79 of which included main rhythm disorders, and the remaining 164 were nonrhythm disorders in ECG parameters, were analyzed. No statistically significant changes were determined in patients’ nonrhythm ECG disorders with IV Ca-gluconate treatment (P = 0.125). However, nine of the 79 main rhythm disorders due to hyperkalemia improved with calcium gluconate treatment and this change was statistically significant (P < 0.004). CONCLUSION: IV Ca-gluconate therapy was found to be effective, albeit to a limited degree, in main rhythm ECG disorders due to hyperkalemia, but it was not found to be effective in nonrhythm ECG disorders due to hyperkalemia. Therefore, Ca-gluconate may be effective only in the main rhythm disorders due to hyperkalemia.

目的:静脉(IV)钙盐被常规推荐作为严重高钾血症紧急治疗的心脏保护疗法。然而，这一建议的证据水平较低，而且是道听途说。本研究的目的是确定静脉注射葡萄糖酸钙治疗高钾血症的有效性。材料和方法:本前瞻性观察研究纳入了1年以上高钾血症患者和因高钾血症而出现心电图改变的患者。在静脉注射葡萄糖酸钙治疗前后和钾水平正常化后，测量患者的心电图。采用Wilcoxon试验和McNemar试验比较葡萄糖酸盐治疗前后的心电图参数。结果:符合纳入标准的111例患者平均钾值为7.1±0.6 mmol/l。本研究共分析243例与高钾血症相关的心电图病理，其中79例为主要节律障碍，其余164例为心电图参数非节律障碍。静脉注射葡萄糖酸钙治疗患者的非节律性心电图疾病无统计学意义变化(P = 0.125)。然而，79例高钾血症引起的主要节律障碍中有9例在葡萄糖酸钙治疗后得到改善，这一变化具有统计学意义(P < 0.004)。结论:葡萄糖酸钠静脉治疗对高钾血症引起的主要心律失常有一定的疗效，但对高钾血症引起的非心律失常无明显疗效。因此，葡萄糖酸钙可能仅对高钾血症引起的主要节律障碍有效。

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引用次数: 2

Messenger ribonucleic acid vaccine-associated immune thrombocytopenia: A rare complication of vaccine. 信使核糖核酸疫苗相关的免疫性血小板减少:一种罕见的疫苗并发症。

IF 0.9 Q2 Medicine

Turkish Journal of Emergency Medicine

Pub Date : 2022-04-01 DOI: 10.4103/2452-2473.342810

Mehmet Sami Islamoglu, Mehmet Dokur, Betul Borku Uysal, Mehmet Gunduz

Coronavirus disease-2019 continues to have a serious impact in countries with the effect of new variant viruses emerging with mutations. While the effectiveness and protection of the vaccine have been determined all over the world, some vaccine-related side effects can be detected in the form of cases. In our case, the patient was admitted to the emergency department of our hospital with complaints of weakness and progressive rash on his legs. Diffuse petechiae purpura on the legs of the patient was observed and complete blood count revealed thrombocytopenia. Peripheral blood smear supported the blood count test results with thrombocytopenia, secondary causes of thrombocytopenia were excluded, and the patient was diagnosed with vaccine-induced immune thrombocytopenia.

2019冠状病毒病继续对各国产生严重影响，新变异病毒出现了突变。虽然疫苗的有效性和保护作用在世界各地都已得到确定，但可以以病例的形式发现一些与疫苗有关的副作用。在我们的病例中，患者因虚弱和腿部进行性皮疹而被送往我院急诊科。患者腿部可见弥漫性瘀点紫癜，全血细胞计数显示血小板减少。外周血涂片支持血小板减少的血细胞计数检查结果，排除血小板减少的继发原因，诊断为疫苗性免疫性血小板减少症。

引用次数: 1

Accuracy of emergency physicians' interpretation of computed tomography for urgent-emergent diagnoses in nontraumatic cases. 急诊医师对非创伤性病例急诊诊断的计算机断层扫描解释的准确性。

IF 0.9 Q2 Medicine

Turkish Journal of Emergency Medicine

Pub Date : 2022-04-01 DOI: 10.4103/2452-2473.342804

Omer Faruk Karakoyun, Nalan Kozaci, Mustafa Avci, Huseyin Uzunay

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.

目的:本研究的目的是评估急诊医生(EPs)在解释胸部和腹部计算机断层扫描(CT)的紧急病理发现时的准确性水平。方法:EPs对因非创伤性原因就诊的急诊患者的CT扫描进行解释。然后，放射学讲师对这些CT扫描结果进行最终评估。根据放射学讲师的解释，计算EPs对CT扫描解释的假阳性率、假阴性率、敏感性、特异性、阳性预测值、阴性预测值和kappa系数(κ)。结果:在我们的研究中，共评估了268个胸部和185个腹部CT扫描。EPs对胸部CT扫描的总体敏感性和特异性分别为90%和89%，而腹部CT的总体敏感性和特异性分别为88%和86%。在气胸、肺栓塞、胸膜积液、实质病理、肿块的诊断上，EPs与指导医师的诊断具有良好的一致性(κ: 0.90， κ: 0.87， κ: 0.71， κ: 0.79， κ: 0.91)，在腹内游离液、腹内游离气、主动脉病理、脾病理、胆囊病理、肠系膜动脉栓塞、阑尾炎、妇科病理、肾脏病理诊断上，EPs与指导医师的诊断具有良好的一致性(κ: 1， κ: 1)。κ0.92,κ:0.96:0.88,κ:0.80,κ:0.79,κ:0.89,κ:0.88,和κ:分别为0.82)。结论:EPs在解释胸部和腹部CT扫描中的紧急病理表现方面是成功的。

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引用次数: 1