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Accelerated CT-screening of high-risk patients in an emergency department

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ACCELERATED CT-SCREENING OF HIGH-RISK PATIENTS IN AN EMERGENCY DEPARTMENT

 Objective

To investigate the feasibility of an accelerated “multiple-rule-out” CT-screening of high-risk patients presenting in the Emergency Department (ED) and its impact on clinical decision making.

Background

Previous studies show that patients triaged as high risk (Red) or moderate-to-high risk (Orange) based on vital parameters, according to local triage algorithm (Danish Emergency Process Triage), have a high 30-day mortality rate (10-30%). For this group of patients, screening with a multi-rule-out CT scan might be beneficial, but at the cost of radiation exposure and additional exams without diagnostic significance

Method

Patients > 40 years triaged as moderate to high risk based on vital parameters were eligible for inclusion. All patients were scanned with an arterial ECG gated flash scan from crista iliac to vertex, a venous Dual Energy abdomen scan, followed by a Dual Energy cerebrum scan. The radiologist provided the findings within an hour from inclusion (multiple-rule-out of >33 acute conditions). Impact of CT-screening on patient diagnosis and treatment was examined prospectively by two physicians separately. Any disputes were settled by third party.

Results

(Preliminary) 100 patients [53% female, 73yrs (43-94)] received a mean radiation dose of 16.3 mSv (size specific dose estimates). Mean time from inclusion to report was 58 minutes (73% within an hour, see figure).


The
CT-screening disproved primary diagnosis in n=16 (16%) patients and resulted in acute treatment change for n= 11 (11%) patients. Based on the result from the CT-screening, additional examinations were performed in n=29 (29%) patients and 15 of these had a clinical impact. Previously unrecognized malignant tumors were found in n=9 (9%) patients. The 30-day-mortality of included patients was 7%.

Conclusion

Accelerated CT-screening of high-risk patients in an ED was feasible andchanged the clinical course in a substantial   proportion of patients. Larger randomized studies are needed to further evaluate the clinical impact of these findings



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